Cost-related non-adherence to glaucoma medical therapy: a hospital based study in Sudurpaschim Province of Nepal

Long-term medical therapy is essential for glaucoma management, but adherence is often suboptimal. Medication cost is a potentially modifiable barrier, particularly in resource-limited settings. To assess the prevalence of cost-related non-adherence (CRNA) to glaucoma medication and to identify factors associated with CRNA among patients receiving medical therapy. A hospital-based cross-sectional study was conducted from 1 October 2023 to 31 March 2024 at Dhangadhi Netralaya Eye Hospital in Sudurpaschim province of Nepal. Consecutive patients aged ≥ 18 years who had been receiving topical glaucoma medication for at least six months were included. Sociodemographic and clinical information were collected through structured questionnaire and medical record review. CRNA was defined as the presence of at least one cost-saving behavior related to glaucoma medication use in the preceding six months. The prevalence of CRNA was estimated with 95% confidence intervals (CI). Bivariate analyses were performed to examine associations between CRNA and potential predictors, followed by multivariable logistic regression to adjust for confounding variables. A p-value < 0.05 was considered statistically significant. A total of 132 patients were included (60.6% male), with a mean age of 60.1 ± 12.6 years. Primary open-angle glaucoma was the most common diagnosis (65.9%). Cost-related non-adherence was reported by 14 participants, corresponding to a prevalence of 10.6% (95% CI: 6.1–17.5). Visual impairment was present in 53.0% of participants, while 15.2% were blind. Most participants were prescribed one glaucoma medication bottle (62.9%), while 28.8% and 8.3% were prescribed two and three bottles, respectively. In multivariable logistic regression analysis, systemic comorbidities (adjusted odds ratio [AOR] 23.05, 95% CI 2.32–374.36) and a higher number of prescribed glaucoma medication bottles (AOR 6.76, 95% CI 2.31–25.73) were independently associated with higher odds of CRNA, whereas male sex was associated with lower odds of CRNA (AOR 0.11, 95% CI 0.02–0.55). Cost-related non-adherence to glaucoma medication affected approximately one in ten patients in this Nepalese cohort. Patients with systemic comorbidities and those prescribed multiple glaucoma medications were at greater risk. Strategies to reduce out-of-pocket costs and simplify treatment regimens may help improve adherence and long-term glaucoma outcomes. The study has been completed, including participant recruitment, data collection, analysis, and interpretation.