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Background: Latanoprost, a prostaglandin inhibitor, is increasingly being used in the therapeutic management of glaucoma. However, there is scant literature examining the cost and outcome ramifications of latanoprost., Objectives: This study examined the medication use behavior (medication-related persistence and adherence rates) and costs associated with the introduction of latanoprost therapy in a treatment-naive older population (aged >or=65 years) enrolled in Medicare., Methods: The study employed a retrospective observational cohort design and used administrative claims data from a Medicare health maintenance organization (HMO), which offered complete coverage to enrollees, including prescription benefits. The case group consisted of patients with glaucoma who began latanoprost therapy. The control group consisted of enrollees with glaucoma who started any therapy other than latanoprost. Both groups were followed up for 1 year before and after initiation of therapy. Bivariate and multivariate techniques incorporating health care utilization in the year before the start of new therapy were used to determine the study outcomes., Results: The case group comprised 101 patients (mean age, 77.60 years), while the control group included 168 patients (mean age, 77.59 years). There were no significant differences across the 2 groups with respect to age, sex, general health scores on the 12 item Short-Form Health Survey, severity of comorbidity, or the proportion of respondents with perception of worsened health. Introduction of latanoprost therapy was associated with higher medication persistence (hazard ratio, 0.90; 95% CI, 0.68-0.98) and adherence rates (mean [SD], 0.51 [0.26] vs 0.40 [0.25]; P < 0.001) compared with patients starting other glaucoma medication. Furthermore, there were no additional increases in total health care costs in the entire population associated with the introduction of latanoprost therapy, after adjusting for group and time effects, as well as other confounders (mean [SD], $4718.24 [$8982.92] vs $4046.55 [$6505.39])., Conclusions: Latanoprost therapy offered improved medication use behavior in these older adults enrolled in a Medicare HMO. There were no significant additional increases in overall health care costs as a result of introduction of latanoprost therapy, after adjusting for group and time effects, as well as other baseline confounders in this study cohort.

Background: Glaucoma is an important public health concern in the United States, particularly among older adults (aged >or=65 years). Pharmacologic therapy for glaucoma consists mainly of topical eye drops containing beta-blockers or prostaglandin analogs., Objective: The goal of this study was to assess the associations between factors of topical medication use (self reported medication compliance, belief in benefit of medication use, usage difficulty, usage assistance, and complexity of medication regimen) and health-related quality of life (HRQOL) in a cross-sectional population of older patients with glaucoma., Methods: A self-administered, 48-question survey soliciting information on medication-taking behaviors, treatmen-trelated factors, and HRQOL was mailed to members of a Medicare health maintenance organization who were aged >or=65 years and had primary open-angle glaucoma. Two mailings were conducted 4 months apart; the second was sent to members whose responses to the first mailing had not yet been received. The 12-Item Short-Form Health Survey (SF-12) and the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) were used to assess HRQOL. Other questions addressed perceptions of eye drop use in these patients. Multiple regression techniques were used to analyze associations between medication-related factors and HRQOL in this population., Results: The questionnaire was mailed to 589 patients; 375 responded (218 in the first mailing and 157 in the second mailing). A total of 358 responses were complete and analyzable (effective response rate, 62%). After controlling for the effects of other confounders, we found that self reported difficulty in using eye drops was strongly associated with decreased HRQOL (11.5% in VFQ-25 total score and 8.4% in SF-12 mental health score, P<0.05). Other medication-related factors that were examined were not significantly associated with changes in HRQOL., Conclusion: Based on our findings, patients aged >or=65 years with glaucoma were likely to have significant comorbidity, which affected both visual and general health and well-being perception. Additionally, a significant proportion of these patients reported difficulty with use of topical medication, which was independently associated with a significant decrease in HRQOL. Care of older patients with glaucoma should incorporate strategies to minimize the difficulty associated with medication use.