Enkhe Badamgarav

Systematic Review and Meta-analysis of Real-World Adherence to Drug Therapy for Osteoporosis

OBJECTIVE To quantify the adherence of patients to drug therapy for osteoporosis in real-world settings via a systematic review and meta-analysis of observational studies. METHODS The PubMed and Cochrane databases were searched for English-language observational studies published from January 1, 1990, to February 15, 2006, that assessed patient adherence to drug therapy for osteoporosis using the following medical subject headings and keywords: drug therapy, medication adherence, medication persistence, medication possession ratio, patient compliance, and osteoporosis. Studies were stratified into 3 groups: persistence (how long a patient continues therapy), compliance (how correctly, in terms of dose and frequency, a patient takes the medication), and adherence (a combination of persistence and compliance). A random-effects model was used to pool results from the selected studies. RESULTS Twenty-four studies were included in the meta-analysis. The pooled database-derived persistence rate was 52% (95% confidence interval [CI], 44%-59%) for treatment lasting 1 to 6 months, 50% (95% CI, 37%-63%) for treatment lasting 7 to 12 months, 42% (95% CI, 20%-68%) for treatment lasting 13 to 24 months, returning to 52% (95% CI, 45%-58%) for treatment lasting more than 24 months. Pooled adherence rates decreased from 53% (95% CI, 52%-54%) for treatment lasting 1 to 6 months to 43% for treatment lasting 7 to 12 months (95% CI, 38%-49%) or 13 to 24 months (43%; 95% CI, 32%-54%). The pooled refill compliance estimate was 68% (95% CI, 63%-72%) for treatment lasting 7 to 12 months and 68% (95% CI, 67%-69%) for treatment lasting 13 to 24 months. The pooled self-reported compliance rate was 62% (95% CI, 48%-75%) for treatment lasting 1 to 6 months and 66% (95% CI, 45%-81%) for treatment lasting 7 to 12 months. CONCLUSION One-third to half of patients do not take their medication as directed. Nonadherence occurs shortly after treatment initiation. Terms and definitions need to be standardized to permit comparability of technologies designed to improve patient adherence. Prospective trials are needed to assess the relationship between adherence and patient outcomes.

Osteoporotic Fractures: A Systematic Review of US Healthcare Costs and Resource Utilization

Osteoporotic fractures are costly in terms of both the dollar amount and healthcare utilization. The objective of this review was to systematically synthesize published evidence regarding direct costs associated with the treatment of osteoporosis-related fractures in the US.We conducted a systematic literature review of published studies that used claims databases and economic studies reporting costs associated with osteoporosis-related fractures in the US. Studies published between 1990 and 2011 were systematically searched in PubMed (primary source), Ovid HealthSTAR, EMBASE and the websites of large agencies. Data concerning study design, patient population and cost components assessed were extracted with qualitative assessment of studymethods, limitations and conclusions. Cost assessment included direct medical and hospitalization (inpatient) costs. The cost differences by age and gender were examined.Of the 33 included studies, 26 reported an estimated total medical cost and hospital resource use associated with osteoporotic fractures. These studies indicated that, in the year following a fracture, medical and hospitalization costs were 1.6–6.2 higher than pre-fracture costs and 2.2–3.5 times higher than those for matched controls. Analysis of the hospitalization costs by osteoporotic fracture type resulted in hip fractures identified as the most expensive fracture type (unit cost range

Direct healthcare costs of hip, vertebral, and non-hip, non-vertebral fractures☆

US8358–32 195), while wrist and forearm fractures were the least expensive (unit cost range

A Meta-Analysis of Osteoporotic Fracture Risk with Medication Nonadherence

US1885–12 136). Although incremental fracture costs were generally lower in the elderly than in the younger population, total costs were highest for the older (≥65 years of age) population. Total healthcare costs for fractures were highest for the older female population, but unit fracture costs in women were not consistently found to be higher than for men. The qualitative assessment of the included studies demonstrated that the design and reporting of individual studies were of good quality. However, the findings of this review and comparisons across studies were limited by differences in methodologies used by the different studies to derive costs, the populations included in the studies used and the fracture assessment.Despite the variability in estimates, the literature indicates that osteoporosisrelated fractures are associated with high total medical and hospitalization costs in the US. The variability in the cost estimates highlights the importance of comparing the methodologies and the types of costs used when choosing an appropriate unit cost for economic modelling.

Cost burden of second fracture in the US health system.

Limited data exist regarding the cost of non-hip, non-vertebral (NHNV) fractures. Although NHNV fractures may be less expensive than hip and vertebral fractures, they have a higher incidence rate. The objective of this study was to quantify first-year healthcare costs of hip, vertebral, and NHNV fractures. This was a claims-based retrospective analysis using a case-control design among patients with commercial insurance and Medicare employer-based supplemental coverage. Patients were > or =50 years old with a closed hip, vertebral, or NHNV fracture between 7/1/2001 and 12/31/2004, and continuous enrollment 6 months prior to and 12 months after the index fracture. Adjusted mean first-year healthcare costs associated with these fractures were determined. Six cohorts were identified. Patients 50-64 years: NHNV (n=27,424), vertebral (n=3386) and hip (n=2423); patients > or =65 years: NHNV (n=40,960), vertebral (n=11,751) and hip (n=21,504). The ratio of NHNV to hip fractures was 11:1 in the 50-64 cohort and 2:1 in the > or =65 cohort. Adjusted mean first-year costs associated with hip, vertebral, and NHNV fractures were

Effect of adherence on lifetime fractures in osteoporotic women treated with daily and weekly bisphosphonates.

26,545,

PMS12 COST OF SECOND FRACTURE AMONG MEDICARE PATIENTS WITH INITIAL HIP, VERTEBRAL, AND NON-HIP NON-VERTEBRAL (NHNV) FRACTURES

14,977, and

PMS9 COST BURDEN OF SECOND FRACTURE IN PATIENTS WITH COMMERCIAL INSURANCE

9183 for the 50-64 age cohort, and

A New Look at Osteoporosis Outcomes: The Influence of Treatment, Compliance, Persistence, and Adherence

15,196,

PMS35 A Cost-Effectiveness Analysis of Denosumab for the Treatment of Post-Menopausal Osteoporosis in Greece

6701, and