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Potential clinical and economic impact of nonadherence with osteoporosis medications.
Calcif Tissue Int. 2010 Mar; 86(3):202-10.CT

Abstract

This study aims to estimate the potential clinical and economic implications of therapeutic adherence to bisphosphonate therapy. A validated Markov microsimulation model was used to estimate the impact of varying adherence to bisphosphonate therapy on outcomes (the number of fractures and the quality-adjusted life-years [QALYs]), health-care costs, and the cost-effectiveness of therapy compared with no treatment. Adherence was divided into persistence and compliance, and multiple scenarios were considered for both concepts. Analyses were performed for women aged 65 years with a bone mineral density T-score of -2.5. Health outcomes and the cost-effectiveness of therapy improved significantly with increasing compliance and/or persistence. In the case of real-world persistence and with a medical possession ratio (MPR; i.e., the number of doses taken divided by the number of doses prescribed) of 100%, the QALY gain and the number of fractures prevented represented only 48 and 42% of the values estimated assuming full persistence, respectively. These proportions fell to 27 and 23% with an MPR value of 80%. The costs per QALY gained, for branded bisphosphonates (and generic alendronate), were estimated at 19,069 euros (4,871 euros), 32,278 euros (11,985 euros), and 64,052 euros (30,181 euros) for MPR values of 100, 80, and 60%, respectively, assuming real-world persistence. These values were 16,997 euros (2,215 euros), 24,401 euros (6,179 eruos), and 51,750 euros (20,569 euros), respectively, assuming full persistence. In conclusion, poor compliance and failure to persist with osteoporosis medications results not only in deteriorating health outcomes, but also in a decreased cost-effectiveness of drug therapy. Adherence therefore remains an important challenge for health-care professionals treating osteoporosis.

Authors+Show Affiliations

HEC-ULg Management School, University of Liège, Boulevard du Rectorat 7, Bât. B31, 4000 Liège, Belgium. m.hiligsmann@ulg.ac.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

20205345

Citation

Hiligsmann, Mickaël, et al. "Potential Clinical and Economic Impact of Nonadherence With Osteoporosis Medications." Calcified Tissue International, vol. 86, no. 3, 2010, pp. 202-10.
Hiligsmann M, Rabenda V, Gathon HJ, et al. Potential clinical and economic impact of nonadherence with osteoporosis medications. Calcif Tissue Int. 2010;86(3):202-10.
Hiligsmann, M., Rabenda, V., Gathon, H. J., Ethgen, O., & Reginster, J. Y. (2010). Potential clinical and economic impact of nonadherence with osteoporosis medications. Calcified Tissue International, 86(3), 202-10.
Hiligsmann M, et al. Potential Clinical and Economic Impact of Nonadherence With Osteoporosis Medications. Calcif Tissue Int. 2010;86(3):202-10. PubMed PMID: 20205345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Potential clinical and economic impact of nonadherence with osteoporosis medications. AU - Hiligsmann,Mickaël, AU - Rabenda,Véronique, AU - Gathon,Henry-Jean, AU - Ethgen,Olivier, AU - Reginster,Jean-Yves, PY - 2010/3/6/entrez PY - 2010/3/6/pubmed PY - 2010/6/18/medline SP - 202 EP - 10 JF - Calcified tissue international JO - Calcif Tissue Int VL - 86 IS - 3 N2 - This study aims to estimate the potential clinical and economic implications of therapeutic adherence to bisphosphonate therapy. A validated Markov microsimulation model was used to estimate the impact of varying adherence to bisphosphonate therapy on outcomes (the number of fractures and the quality-adjusted life-years [QALYs]), health-care costs, and the cost-effectiveness of therapy compared with no treatment. Adherence was divided into persistence and compliance, and multiple scenarios were considered for both concepts. Analyses were performed for women aged 65 years with a bone mineral density T-score of -2.5. Health outcomes and the cost-effectiveness of therapy improved significantly with increasing compliance and/or persistence. In the case of real-world persistence and with a medical possession ratio (MPR; i.e., the number of doses taken divided by the number of doses prescribed) of 100%, the QALY gain and the number of fractures prevented represented only 48 and 42% of the values estimated assuming full persistence, respectively. These proportions fell to 27 and 23% with an MPR value of 80%. The costs per QALY gained, for branded bisphosphonates (and generic alendronate), were estimated at 19,069 euros (4,871 euros), 32,278 euros (11,985 euros), and 64,052 euros (30,181 euros) for MPR values of 100, 80, and 60%, respectively, assuming real-world persistence. These values were 16,997 euros (2,215 euros), 24,401 euros (6,179 eruos), and 51,750 euros (20,569 euros), respectively, assuming full persistence. In conclusion, poor compliance and failure to persist with osteoporosis medications results not only in deteriorating health outcomes, but also in a decreased cost-effectiveness of drug therapy. Adherence therefore remains an important challenge for health-care professionals treating osteoporosis. SN - 1432-0827 UR - https://www.unboundmedicine.com/medline/citation/20205345/Potential_clinical_and_economic_impact_of_nonadherence_with_osteoporosis_medications_ L2 - http://www.diseaseinfosearch.org/result/9059 DB - PRIME DP - Unbound Medicine ER -