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Evaluating the claim of enhanced persistence: the case of osteoporosis and implications for payers.
Med Decis Making. 2009 Nov-Dec; 29(6):690-706.MD

Abstract

Cost-effectiveness analysis (CEA) has been widely used in evaluating treatments for osteoporosis. To study the claim of enhanced persistence, this research determined the effects of persistence (the proportion of individuals who remain on treatment) and efficacy on incremental cost-effectiveness ratios (ICERs) for bisphosphonate treatment relative to no bisphosphonate treatment in the United States. For 2 age groups, 55 to 59 and 75 to 79, the authors relied on published fracture rates and applied them to 1000 postmenopausal osteoporotic patients with bone mineral density (BMD) T score < or = -2.5 during 3 years of treatment. After developing an algebraic ICER, with effectiveness measured by either quality-adjusted life years (QALYs) gained or number of fractures averted, they determined the effects of persistence and efficacy and then calibrated the model to variable estimates from the literature. For the younger (older) cohort, the cost per fracture averted was $66,606 ($18,256), consistent with a validated Markov simulation model. The effect of a 1 percentage point change in vertebral efficacy was 24 (5) times the effect of a 1 percentage point change in persistence for the younger cohort when QALYs (fractures) were involved. Nonvertebral efficacy had approximately 27 (9) times the effect of persistence. For the older cohort, the ratios were 15 (4.5) and 33 (10) for vertebral and nonvertebral fractures, respectively. In evaluating the claim of enhanced persistence, formulary decision makers need to exercise caution to ensure that efficacy is not compromised. Two drugs would have to be virtually identical in efficacy for better persistence to improve cost-effectiveness.

Authors+Show Affiliations

College of Business, University of Cincinnati, Cincinnati, 90 West Daniels, Cincinnati, OH 45221-0223, USA. chris.kelton@uc.eduNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

19542361

Citation

Kelton, Christina M L., and Margaret K. Pasquale. "Evaluating the Claim of Enhanced Persistence: the Case of Osteoporosis and Implications for Payers." Medical Decision Making : an International Journal of the Society for Medical Decision Making, vol. 29, no. 6, 2009, pp. 690-706.
Kelton CM, Pasquale MK. Evaluating the claim of enhanced persistence: the case of osteoporosis and implications for payers. Med Decis Making. 2009;29(6):690-706.
Kelton, C. M., & Pasquale, M. K. (2009). Evaluating the claim of enhanced persistence: the case of osteoporosis and implications for payers. Medical Decision Making : an International Journal of the Society for Medical Decision Making, 29(6), 690-706. https://doi.org/10.1177/0272989X09336143
Kelton CM, Pasquale MK. Evaluating the Claim of Enhanced Persistence: the Case of Osteoporosis and Implications for Payers. Med Decis Making. 2009 Nov-Dec;29(6):690-706. PubMed PMID: 19542361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluating the claim of enhanced persistence: the case of osteoporosis and implications for payers. AU - Kelton,Christina M L, AU - Pasquale,Margaret K, Y1 - 2009/06/19/ PY - 2009/6/23/entrez PY - 2009/6/23/pubmed PY - 2010/3/2/medline SP - 690 EP - 706 JF - Medical decision making : an international journal of the Society for Medical Decision Making JO - Med Decis Making VL - 29 IS - 6 N2 - Cost-effectiveness analysis (CEA) has been widely used in evaluating treatments for osteoporosis. To study the claim of enhanced persistence, this research determined the effects of persistence (the proportion of individuals who remain on treatment) and efficacy on incremental cost-effectiveness ratios (ICERs) for bisphosphonate treatment relative to no bisphosphonate treatment in the United States. For 2 age groups, 55 to 59 and 75 to 79, the authors relied on published fracture rates and applied them to 1000 postmenopausal osteoporotic patients with bone mineral density (BMD) T score < or = -2.5 during 3 years of treatment. After developing an algebraic ICER, with effectiveness measured by either quality-adjusted life years (QALYs) gained or number of fractures averted, they determined the effects of persistence and efficacy and then calibrated the model to variable estimates from the literature. For the younger (older) cohort, the cost per fracture averted was $66,606 ($18,256), consistent with a validated Markov simulation model. The effect of a 1 percentage point change in vertebral efficacy was 24 (5) times the effect of a 1 percentage point change in persistence for the younger cohort when QALYs (fractures) were involved. Nonvertebral efficacy had approximately 27 (9) times the effect of persistence. For the older cohort, the ratios were 15 (4.5) and 33 (10) for vertebral and nonvertebral fractures, respectively. In evaluating the claim of enhanced persistence, formulary decision makers need to exercise caution to ensure that efficacy is not compromised. Two drugs would have to be virtually identical in efficacy for better persistence to improve cost-effectiveness. SN - 1552-681X UR - https://www.unboundmedicine.com/medline/citation/19542361/Evaluating_the_claim_of_enhanced_persistence:_the_case_of_osteoporosis_and_implications_for_payers_ L2 - https://journals.sagepub.com/doi/10.1177/0272989X09336143?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -