Ariane Höer

Influence on persistence and adherence with oral bisphosphonates on fracture rates in osteoporosis

Background and Aim: Oral bisphosphonates have been shown to reduce the risk of fractures in patients with osteoporosis. It can be assumed that the clinical effectiveness of oral bisphosphonates depends on persistence with therapy. Methods: The influence of persistence with and adherence to oral bisphosphonates on fracture risk in a real-life setting was investigated. Data from 4451 patients with a defined index prescription of bisphosphonates were included. Fracture rates within 180, 360, and 720 days after index prescription were compared between persistent and non-persistent patients. In an extended Cox regression model applying multiple event analysis, the influence of adherence was analyzed. Persistence was defined as the duration of continuous therapy; adherence was measured in terms of the medication possession ratio (MPR). Results: In patients with a fracture before index prescription, fracture rates were reduced by 29% (p = 0.025) comparing persistent and non-persistent patients within 180 days after the index prescription and by 45% (p < 0.001) within 360 days. The extended Cox regression model showed that good adherence (MPR ≥ 0.8) reduced fracture risk by about 39% (HR 0.61, 95% CI 0.47–0.78; p < 0.01). Conclusions: In patients with osteoporosis-related fractures, good persistence and adherence to oral bisphosphonates reduced fracture risk significantly.

Multiple sclerosis in Germany: data analysis of administrative prevalence and healthcare delivery in the statutory health system

BackgroundHealthcare-utilization data for multiple sclerosis (MS) are scarce in Germany. The Purpose of the study was to analyse administrative prevalence of MS, medication use and type of specialists involved in MS treatment in the outpatient setting in Bavaria.MethodsPseudonymized claims data from Bavarian Statutory Health Insurance (SHI)-accredited physicians were used. Administrative prevalence of MS was defined as having ≥1 MS diagnosis (International Classification of Diseases, 10th edition, code G35) documented by a neurologist or psychiatrist, or ≥1 prescription for disease-modifying drugs (DMDs)). The administrative prevalence calculated for Bavaria was projected to Germany. DMD prescription and involvement of different specialities in health care service for MS patients was analysed.ResultsAdministrative prevalence of MS in Bavaria increased from 0.123% to 0.175% of insured persons between 2005 and 2009; when projected, this yielded ~102,000–143,000 patients with MS in the German population. The percentage of patients receiving ≥1 DMD prescription increased from 45.5% to 50.5%. Patients with MS were mainly treated by neurologists in the ambulatory care setting.ConclusionsThese results provide important information on the administrative prevalence of MS in Bavaria and on healthcare provision for patients, which is relevant for resource planning in the healthcare sector.

Value of generic medicines: an health economics study

Background Generic medicines provide an opportunity to obtain similar treatments at lower costs for patients and payers, while liberating budgets for financing new innovative medicines. The debate on generic medicines has been centered on affordability and cost-savings so far. Positive health impact of generic medicines has, however, been scarcely discussed. The aim of the study is to examine the value of generic medicines in a more comprehensive way, particularly including the patient-related value. This involves generic medicines’ health impact in terms of not only medication adherence and compliance, but also in terms of health outcomes measured by primary endpoints or by more comprehensive health benefit measures as well as public health aspects.

Methodische Erläuterun gen

Es gibt viele verschiedene Einflussfaktoren auf die Entwicklung der Arzneimittelausgaben der GKV. Darunter sind nachfrage- und angebotsseitige Faktoren, die sich aus dem objektiven und subjektiven Bedarf sowie der politischen Steuerung ergeben.

Zusammenfassung – Das Wichtigste in Kürze

Im Jahr 2013 anderten sich die gesetzlichen Rahmenbedingungen fur die ambulante Arzneimittelversorgung in der gesetzlichen Krankenversicherung (GKV) kaum, weshalb der Ausgabenanstieg 2013 wieder der langfristigen Marktentwicklung entsprach.