Cost-related nonadherence with glaucoma medications in Ontario

Published:February 03, 2021DOI:



      To determine the proportion of glaucoma patients in Ontario aged 25–64 who lack insurance coverage for glaucoma medications and to assess the frequency of cost-related nonadherence to glaucoma medications.


      Cross-sectional study.


      Glaucoma patients on medication from 2 glaucoma clinics in Toronto, Ontario.


      100 consecutive glaucoma patients aged 25–64 (not entitled to provincial drug benefit) and 100 consecutive glaucoma patients aged 65+ (entitled to provincial drug benefit), all on topical glaucoma therapy, completed a standardized questionnaire. Questions included insurance coverage for glaucoma medications, cost concerns when paying for glaucoma medications, cost-related nonadherence, and sociodemographics.


      25.8% of those aged 25–64 express concerns about the cost of their glaucoma medications compared to 7.1% of those aged 65+ (p < 0.001). Patients aged 25–64 were also significantly more likely to report at least one form of cost-related nonadherence (15.5% vs 2.0%, p = 0.001) and significantly more likely to report missing eye drops in a given week than patients aged 65+ (32.0% vs 16.7%, p = 0.01). 17% (95% confidence interval 11%–26%) of patients aged 25–64 self-reported having no insurance coverage for their glaucoma medications. Of those with coverage, the most common source of insurance was employer-sponsored (68.6%) with 44% requiring a copayment. The average copayment was $18 (range $2–$250) for those aged 25–64 compared with $5 in the 65+ group (range $0.62–$100).


      17% of glaucoma patients aged 25–64 do not have coverage for their drops. One in four expressed concerns about the cost of their glaucoma medications, and 15.5% reported cost-related nonadherence.


      Déterminer la proportion de patients âgés de 25 à 64 ans qui présentent un glaucome et qui ne bénéficient d'aucune couverture d'assurance pour leurs médicaments antiglaucomateux en Ontario, et évaluer la fréquence du non-respect du traitement antiglaucomateux en raison du coût de ce dernier.


      Étude transversale.


      Patients sous médicaments antiglaucomateux issus de 2 cliniques de traitement du glaucome à Toronto, en Ontario.


      Cent patients consécutifs qui présentaient un glaucome et qui étaient âgés entre 25 et 64 ans (qui ne sont donc pas admis au régime provincial d'assurance-médicaments) et 100 patients consécutifs qui présentaient un glaucome et qui étaient âgés de 65 ans et plus (qui sont donc admis au régime provincial d'assurance-médicaments) ont répondu à un questionnaire standardisé. Les 200 sujets recevaient des collyres antiglaucomateux. Les questions portaient sur la couverture d'assurance pour les médicaments antiglaucomateux, les inquiétudes quant au paiement de tels médicaments, le non-respect du traitement en raison du coût et les paramètres sociodémographiques.


      Quelque 25,8 % des sujets âgés entre 25 et 64 ans ont signalé avoir des inquiétudes quant au coût de leurs médicaments antiglaucomateux, comparativement à 7,1 % des sujets âgés de 65 ans et plus (p < 0,001). De même, les patients âgés entre 25 et 64 ans étaient significativement plus susceptibles de signaler au moins une forme de non-respect du traitement en raison de son coût (15,5 % vs 2,0 %; p = 0,001), et significativement plus susceptibles de signaler avoir manqué des doses de leurs collyres pendant une semaine donnée, comparativement aux patients âgés de 65 ans et plus (32,0 % vs 16,7 %; p = 0,01). Par ailleurs, 17 % (intervalle de confiance à 95 % : 11 %–26 %) des patients âgés entre 25 et 64 ans ont signalé n'avoir aucune assurance pour leurs médicaments antiglaucomateux. Pour ce qui est des patients qui bénéficiaient d'une couverture d'assurance, la source la plus fréquente de l'assurance était celle de l'employeur (68,6 %), qui exigeait une quote-part dans 44 % des cas. La quote-part moyenne s’élevait à 18 $ (fourchette : 2 $ à 250 $) pour les patients âgés entre 25 et 64 ans et de 5 $ (fourchette : 0,62 $ à 100 $) pour les âgés de 65 ans et plus.


      Ainsi, 17 % des patients qui présentent un glaucome et qui sont âgés entre 25 et 64 ans ne bénéficient d'aucune couverture d'assurance pour leurs collyres. Un patient sur 4 a exprimé une inquiétude quant au coût de ses médicaments antiglaucomateux, et 15,5 % des sujets ont signalé ne pas toujours observer leur traitement médicamenteux en raison de son coût.
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