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Archives of Osteoporosis

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01-12-2017 | Original Article

Adherence to osteoporosis medicines in Estonia—a comprehensive 15-year retrospective prescriptions database study

Authors: Ott Laius, Heti Pisarev, Katre Maasalu, Sulev Kõks, Aare Märtson

Published in: Archives of Osteoporosis | Issue 1/2017

Abstract

Summary

Some patients do not take medicines as they are supposed to. Our research showed that in Estonia, one fifth of patients did not start treatment with osteoporosis medicines and only 20% used the medicines for at least 3 years as they should. This induces unnecessary costs to the healthcare system.

Purpose

Medication non-adherence is the number one reason for not obtaining the expected clinical effect of medicines. With osteoporosis treatment, it has been shown that both implementation of treatment and persistence influence the risk of fractures significantly. Long-term adherence to medication in Estonia is to be determined with this study.

Methods

A 15-year retrospective study was carried out in order to establish initiation, implementation, and persistence of Estonian patients. All new users of osteoporosis medicines were analyzed for all prescriptions they received during the study period. Sufficient adherence to treatment was defined as a patient being dispensed 80% or more prescribed doses for at least 1 year.

Results

The study period was from 2001 to 2015. Patients (24,652) were included in the study. Of the patients, 93.7% (n = 23,091) were women and 6.3% (n = 1564) were men. Eighteen percent (4636) were dispensed only one prescription. Of the patients, 44.2% included in the study had medication possession ratio (MPR) ≥80% over follow-up period; 8922 (36.2%) who were prescribed from 2001 to 2015 persisted for 1 year with MPR ≥80% and 19.8% persisted for 3 years. Forty percent of expenditure on osteoporosis medication was made for treatment courses with insufficient adherence.

Conclusions

There is room for improvement in Estonia with medication adherence relating to all three aspects that determine adherence—initiation, implementation, and persistence. This means further efforts are to be made to educate patients and healthcare professionals on realizing the importance of good adherence.

Burge R, Dawson-Hughes B, Solomon D et al (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone 22:465–475

Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353:487–497CrossRefPubMed

Vrijens B, De Geest S, Hughes DA et al (2012) A new taxonomy for describing and defining adherence to medications: new taxonomy for adherence to medications. Br J Clin Pharmacol 73:691–705. doi:10.1111/j.1365-2125.2012.04167.x CrossRefPubMedPubMedCentral

Feldstein AC, Weycker D, Nichols GA et al (2009) Effectiveness of bisphosphonate therapy in a community setting. Bone 44:153–159. doi:10.1016/j.bone.2008.09.006 CrossRefPubMed

Ström O, Borgstrom F, Zethraeus N et al (2008) Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden. Acta Orthop 79:269–280. doi:10.1080/17453670710015094 CrossRefPubMed

Borgström F, Lekander I, Ivergård M et al (2013) The international costs and utilities related to osteoporotic fractures study (ICUROS)—quality of life during the first 4 months after fracture. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 24:811–823. doi:10.1007/s00198-012-2240-2 CrossRef

Silverman SL, Schousboe JT, Gold DT (2011) Oral bisphosphonate compliance and persistence: a matter of choice? Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 22:21–26. doi:10.1007/s00198-010-1274-6 CrossRef

Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767. doi:10.1016/S0140-6736(02)08657-9 CrossRefPubMed

Hernlund E, Svedbom A, Ivergård M et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136. doi:10.1007/s11657-013-0136-1 CrossRefPubMedPubMedCentral

10.

Ström O, Borgström F, Kanis JA et al (2011) Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 6:59–155. doi:10.1007/s11657-011-0060-1 CrossRefPubMed

11.

McCombs JS, Thiebaud P, McLaughlin-Miley C, Shi J (2004) Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 48:271–287. doi:10.1016/j.maturitas.2004.02.005 CrossRefPubMed

12.

MacLean C, Newberry S, Maglione M et al (2008) Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med 148:197–213CrossRefPubMed

13.

Clowes JA, Peel NFA, Eastell R (2004) The impact of monitoring on adherence and persistence with antiresorptive treatment for postmenopausal osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab 89:1117–1123. doi:10.1210/jc.2003-030501 CrossRefPubMed

14.

Cramer JA, Gold DT, Silverman SL, Lewiecki EM (2007) A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 18:1023–1031. doi:10.1007/s00198-006-0322-8 CrossRef

15.

Caro JJ, Ishak KJ, Huybrechts KF et al (2004) The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos Int 15:1003–1008. doi:10.1007/s00198-004-1652-z CrossRefPubMed

16.

Sabaté E (2003) Adherence to long-term therapies: evidence for action. World Health Organization, Switzerland

17.

Vermeire E, Hearnshaw H, Van Royen P, Denekens J (2001) Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther 26:331–342CrossRefPubMed

18.

Cutler DM, Everett W (2010) Thinking outside the pillbox—medication adherence as a priority for health care reform. N Engl J Med 362:1553–1555. doi:10.1056/NEJMp1002305 CrossRefPubMed

19.

Díez-Pérez A, González-Macías J (2008) Inadequate responders to osteoporosis treatment: proposal for an operational definition. Osteoporos Int 19:1511–1516. doi:10.1007/s00198-008-0659-2 CrossRefPubMed

20.

Karpf DB, Shapiro DR, Seeman E et al (1997) Prevention of nonvertebral fractures by alendronate: a meta-analysis. JAMA 277:1159–1164. doi:10.1001/jama.1997.03540380073035 CrossRefPubMed

21.

Stakkestad JA, Lakatos P, Lorenc R et al (2008) Monthly oral ibandronate is effective and well tolerated after 3 years: the MOBILE long-term extension. Clin Rheumatol 27:955–960. doi:10.1007/s10067-007-0824-6 CrossRefPubMed

22.

Silverman SL, Christiansen C, Genant HK et al (2008) Efficacy of bazedoxifene in reducing new vertebral fracture risk in postmenopausal women with osteoporosis: results from a 3-year, randomized, placebo-, and active-controlled clinical trial*. J Bone Miner Res 23:1923–1934. doi:10.1359/jbmr.080710 CrossRefPubMed

23.

Steiner JF, Prochazka AV (1997) The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol 50:105–116CrossRefPubMed

24.

Estonian Health Insurance Fund. http://www.haigekassa.ee. Accessed 3 Nov 2016

25.

Laius O, Maasalu K, Kõks S, Märtson A (2016) Use of drugs against osteoporosis in the Baltic countries during 2010–2014. Medicina (Mex) 52:315–320. doi:10.1016/j.medici.2016.10.001 CrossRef

26.

Kim H-J, Fay MP, Feuer EJ et al (2000) Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 19:335–351CrossRefPubMed

27.

Siris ES, Selby PL, Saag KG et al (2009) Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. Am J Med 122:S3–13. doi:10.1016/j.amjmed.2008.12.002 CrossRefPubMed

28.

Brankin E, Walker M, Lynch N et al (2006) The impact of dosing frequency on compliance and persistence with bisphosphonates among postmenopausal women in the UK: evidence from three databases. Curr Med Res Opin 22:1249–1256. doi:10.1185/030079906X112688 CrossRefPubMed

29.

Landfeldt E, Ström O, Robbins S, Borgström F (2012) Adherence to treatment of primary osteoporosis and its association to fractures—the Swedish adherence register analysis (SARA). Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 23:433–443. doi:10.1007/s00198-011-1549-6 CrossRef

30.

Gold DT, Safi W, Trinh H (2006) Patient preference and adherence: comparative US studies between two bisphosphonates, weekly risedronate and monthly ibandronate. Curr Med Res Opin 22:2383–2391. doi:10.1185/030079906X154042 CrossRefPubMed

31.

Imaz I, Zegarra P, González-Enríquez J et al (2010) Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 21:1943–1951. doi:10.1007/s00198-009-1134-4 CrossRef

32.

Netelenbos JC, Geusens PP, Ypma G, Buijs SJE (2011) Adherence and profile of non-persistence in patients treated for osteoporosis—a large-scale, long-term retrospective study in The Netherlands

33.

Claxton AJ, Cramer J, Pierce C (2001) A systematic review of the associations between dose regimens and medication compliance. Clin Ther 23:1296–1310CrossRefPubMed

34.

Roughead EE, Ramsay E, Priess K et al (2009) Medication adherence, first episode duration, overall duration and time without therapy: the example of bisphosphonates. Pharmacoepidemiol Drug Saf 18:69–75. doi:10.1002/pds.1687 CrossRefPubMed

35.

Klop C, Welsing PMJ, Elders PJM, et al (2015) Long-term persistence with anti-osteoporosis drugs after fracture. Osteoporos Int 1–10. doi: 10.1007/s00198-015-3084-3

36.

Solomon DH, Avorn J, Katz JN et al (2005) Compliance with osteoporosis medications. Arch Intern Med 165:2414–2419CrossRefPubMed

37.

Hansen C, Pedersen BD, Konradsen H, Abrahamsen B (2013) Anti-osteoporotic therapy in Denmark—predictors and demographics of poor refill compliance and poor persistence. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 24:2079–2097. doi:10.1007/s00198-012-2221-5 CrossRef

38.

Halpern R, Becker L, Iqbal SU et al (2011) The association of adherence to osteoporosis therapies with fracture, all-cause medical costs, and all-cause hospitalizations: a retrospective claims analysis of female health plan enrollees with osteoporosis. J Manag Care Pharm JMCP 17:25–39PubMed

39.

Osteoporosis in the European Union in 2008 (2008) Ten years of progress and ongoing challenges. International Osteoporosis Foundation

40.

Sheehy O, Kindundu C, Barbeau M, LeLorier J (2009) Adherence to weekly oral bisphosphonate therapy: cost of wasted drugs and fractures. Osteoporos Int 20:1583–1594. doi:10.1007/s00198-008-0829-2 CrossRefPubMed

41.

Huybrechts KF, Ishak KJ, Caro JJ (2006) Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone 38:922–928. doi:10.1016/j.bone.2005.10.022 CrossRefPubMed

Title: Adherence to osteoporosis medicines in Estonia—a comprehensive 15-year retrospective prescriptions database study
Authors: Ott Laius
Heti Pisarev
Katre Maasalu
Sulev Kõks
Aare Märtson
Publication date: 01-12-2017
Publisher: Springer London
Published in: Archives of Osteoporosis / Issue 1/2017
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-017-0354-z

At a glance: The STEP trials

Springer Medicine

Adherence to osteoporosis medicines in Estonia—a comprehensive 15-year retrospective prescriptions database study

Abstract

Summary

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusions

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