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A Markov model simulation of the impact of treatment persistence in postmenopausal osteoporosis.
Med Decis Making. 2009 Jan-Feb; 29(1):125-39.MD

Abstract

BACKGROUND

The Markov model followed a cohort of patients over 10 years to estimate the total number of incident osteoporotic fractures by age for the overall population of women with diagnosed postmenopausal osteoporosis in France (mean age, 71.1 years +/-9.6; range, 50-96 years). The impact of clinical efficacy, persistence, and residual treatment effects data on predicted fracture risk was also estimated in the model.

RESULTS

Predicted numbers of incident fractures appeared consistent with published data. Compared with no treatment, the relative risk of fracture over 10 years was 0.831 for weekly bisphosphonate treatment with an assumed persistence rate of 51% after 1 year (absolute risk reduction = 11.4%). This relative risk decreased to 0.731 (absolute risk reduction=18.1%) if hypothetical full-treatment persistence was achieved. In terms of public health, improving persistence with bisphosphonate treatment by only 20% could have the same impact as a 20.2% increase in clinical efficacy. The benefit associated with improved persistence declines as full persistence is approached.

CONCLUSION

Improving persistence can increase treatment effectiveness. Giving greater priority to persistence interventions might have a greater impact on the health of osteoporotic women than advances in treatment efficacy.

Authors+Show Affiliations

CERMES, INSERM U750, National Institute of Health and Medical Research, 7 rue Guy Môquet, Villejuif, France. francois-emery.e.cotte@gsk.frNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18566486

Citation

Cotté, François-Emery, et al. "A Markov Model Simulation of the Impact of Treatment Persistence in Postmenopausal Osteoporosis." Medical Decision Making : an International Journal of the Society for Medical Decision Making, vol. 29, no. 1, 2009, pp. 125-39.
Cotté FE, Fautrel B, De Pouvourville G. A Markov model simulation of the impact of treatment persistence in postmenopausal osteoporosis. Med Decis Making. 2009;29(1):125-39.
Cotté, F. E., Fautrel, B., & De Pouvourville, G. (2009). A Markov model simulation of the impact of treatment persistence in postmenopausal osteoporosis. Medical Decision Making : an International Journal of the Society for Medical Decision Making, 29(1), 125-39. https://doi.org/10.1177/0272989X08318461
Cotté FE, Fautrel B, De Pouvourville G. A Markov Model Simulation of the Impact of Treatment Persistence in Postmenopausal Osteoporosis. Med Decis Making. 2009 Jan-Feb;29(1):125-39. PubMed PMID: 18566486.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Markov model simulation of the impact of treatment persistence in postmenopausal osteoporosis. AU - Cotté,François-Emery, AU - Fautrel,Bruno, AU - De Pouvourville,Gérard, Y1 - 2008/06/19/ PY - 2008/6/21/pubmed PY - 2009/4/1/medline PY - 2008/6/21/entrez SP - 125 EP - 39 JF - Medical decision making : an international journal of the Society for Medical Decision Making JO - Med Decis Making VL - 29 IS - 1 N2 - BACKGROUND: The Markov model followed a cohort of patients over 10 years to estimate the total number of incident osteoporotic fractures by age for the overall population of women with diagnosed postmenopausal osteoporosis in France (mean age, 71.1 years +/-9.6; range, 50-96 years). The impact of clinical efficacy, persistence, and residual treatment effects data on predicted fracture risk was also estimated in the model. RESULTS: Predicted numbers of incident fractures appeared consistent with published data. Compared with no treatment, the relative risk of fracture over 10 years was 0.831 for weekly bisphosphonate treatment with an assumed persistence rate of 51% after 1 year (absolute risk reduction = 11.4%). This relative risk decreased to 0.731 (absolute risk reduction=18.1%) if hypothetical full-treatment persistence was achieved. In terms of public health, improving persistence with bisphosphonate treatment by only 20% could have the same impact as a 20.2% increase in clinical efficacy. The benefit associated with improved persistence declines as full persistence is approached. CONCLUSION: Improving persistence can increase treatment effectiveness. Giving greater priority to persistence interventions might have a greater impact on the health of osteoporotic women than advances in treatment efficacy. SN - 0272-989X UR - https://www.unboundmedicine.com/medline/citation/18566486/A_Markov_model_simulation_of_the_impact_of_treatment_persistence_in_postmenopausal_osteoporosis_ L2 - https://journals.sagepub.com/doi/10.1177/0272989X08318461?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -