Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Osteoporosis International
Published in: Osteoporosis International 1/2009

01-01-2009 | Original Article

Incorporating adherence into health economic modelling of osteoporosis

Authors: O. Ström, F. Borgström, J. A. Kanis, B. Jönsson

Published in: Osteoporosis International | Issue 1/2009

Login to get access

Abstract

Summary

Osteoporosis medications are seldom taken according to the recommendations of health-care providers. A theoretical model was constructed to investigate the variables of drug adherence that affect the cost-effectiveness of drugs, using osteoporosis treatment as a model. Important variables were the magnitude of drug effect, drug price, and fracture-related costs.

Introduction

Adherence to anti-fracture medication is far from optimal and poses a challenge in osteoporosis management. The objectives of this study were to develop a model that could address adherence and identify the important drivers of cost-effectiveness.

Methods

An individual state transition model was constructed to compare two theoretical medications, one of which conferred optimal adherence and was 50% more costly. Adherence was divided into persistence and compliance. Partial compliance was assumed to be associated with a 20% loss of anti-fracture effect. Non-persistent patients had an offset time as long as their time on medication, to a maximum of 5 years.

Results

The potentially important drivers of cost-effectiveness include reduced drug effectiveness due to poor compliance, offset time, fracture risk, anti-fracture drug effect, and drug price. Optimal adherence was associated with fewer osteoporotic fractures, and the impact was more evident among those with prior fractures. However, the health benefits of adherence were often partially offset by increased intervention costs associated with the improved drug-taking behaviour.

Conclusions

High adherence is likely to be associated with added value for health-care systems, but should be used with care as a central health economic argument.
Literature
1.
2.
Cramer JA, Amonkar MM, Hebborn A, Altman R (2005) Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin 21:1453–1460PubMedCrossRef
3.
Seeman E, Compston J, Adachi J, Brandi ML et al (2007) Non-compliance: the Achilles’ heel of anti-fracture efficacy. Osteoporos Int 18:711–719PubMedCrossRef
4.
Huybrechts KF, Ishak KJ, Caro JJ (2006) Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone 38:922–928PubMedCrossRef
5.
Gold DT, Silverman S (2006) Review of adherence to medications for the treatment of osteoporosis. Curr Osteoporos Rep 4:21–27PubMedCrossRef
6.
Jonsson B, Christiansen C, Johnell O, Hedbrandt J et al (1996) Cost-effectiveness of fracture prevention in established osteoporosis. Scand J Rheumatol Suppl 103:30–38PubMedCrossRef
7.
Kanis JA, Borgstrom F, Johnell O, Odén A et al (2005) Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study. Osteoporos Int 16:15–25PubMedCrossRef
8.
Stevenson M, Lloyd Jones M, De Nigris E, Brewer N et al (2005) A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. Health Technol Assess 9:1–160PubMed
9.
Borgstrom F, Jonsson B, Strom O, Kanis JA (2006) An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting: based on the results of the SOTI and TROPOS trials. Osteoporos Int 17:1781–1793PubMedCrossRef
10.
Strom O, Borgstrom F, Sen SS, Boonen S et al (2007) Cost-effectiveness of alendronate in the treatment of postmenopausal women in 9 European countries—an economic evaluation based on the fracture intervention trial. Osteoporos Int 18:1047–1061PubMedCrossRef
11.
Fayers PM, Hand DJ (1997) Generalisation from phase III clinical trials: survival, quality of life, and health economics. Lancet 350:1025–1027PubMedCrossRef
12.
Simon G, Wagner E, Vonkorff M (1995) Cost-effectiveness comparisons using “real world” randomized trials: the case of new antidepressant drugs. J Clin Epidemiol 48:363–373PubMedCrossRef
13.
Solomon DH, Avorn J, Katz JN, Finkelstein JS et al (2005) Compliance with osteoporosis medications. Arch Intern Med 165:2414–2419PubMedCrossRef
14.
Weycker D, Macarios D, Edelsberg J, Oster G (2006) Compliance with drug therapy for postmenopausal osteoporosis. Osteoporos Int 17:1645–1652PubMedCrossRef
15.
16.
Weycker D, Macarios D, Edelsberg J, Oster G (2007) Compliance with osteoporosis drug therapy and risk of fracture. Osteoporos Int 18:271–277PubMedCrossRef
17.
Siris ES, Genant HK, Laster AJ, Chen P et al (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18:761–770PubMedCrossRef
18.
McCloskey E, De Takats D, Orgee J, Aropinn S et al (2005) Characteristics associated with non-persistence during daily therapy. Experience from the placebo wing of a community based clinical trial. J Bone Miner Res 20 [Suppl 1]:S282
19.
Kanis JA, Borgstrom F, De Laet C, Johansson H et al (2005) Assessment of fracture risk. Osteoporos Int 16:581–589PubMedCrossRef
20.
Ekedahl A, Mansson N (2004) Unclaimed prescriptions after automated prescription transmittals to pharmacies. Pharm World Sci 26:26–31PubMedCrossRef
21.
Black DM, Schwartz AV, Ensrud KE, Cauley JA et al (2006) Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 296:2927–2938PubMedCrossRef
22.
Borgstrom F, Johnell O, Kanis JA, Odén A et al (2004) Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden: an economic evaluation based on the MORE study. Pharmacoeconomics 22:1153–1165PubMedCrossRef
23.
Johnell O, Jonsson B, Jonsson L, Black D (2003) Cost effectiveness of alendronate (Fosamax) for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics 21:305–314PubMedCrossRef
24.
Ortolani S, Vai S (2006) Strontium ranelate: an increased bone quality leading to vertebral antifracture efficacy at all stages. Bone 38:19–22PubMedCrossRef
25.
Wallace DJ (2005) Rapid prevention of vertebral fractures associated with osteoporosis. Orthopedics 28:291–298PubMed
26.
27.
Kanis JA, Johnell O, Odén A, Sembo I et al (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674PubMedCrossRef
28.
Kanis JA, Johnell O, Odén A, Jonsson B et al (2000) Risk of hip fracture derived from relative risks: an analysis applied to the population of Sweden. Osteoporos Int 11:120–127PubMedCrossRef
29.
De Laet CE, van Hout BA, Burger H, Hofman A et al (1997) Bone density and risk of hip fracture in men and women: cross sectional analysis. Br Med J 315:221–225
30.
Borgstrom F, Zethraeus N, Johnell O, Lidgren L et al (2005) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 1–14
31.
Johnell O, Gullberg B, Kanis JA (1997) The hospital burden of vertebral fracture in Europe: a study of national register sources. Osteoporos Int 7:138–144PubMedCrossRef
32.
Zethraeus N, Strom O, Borgstrom F (2006) What is the risk of institutionalization after hip fracture? Osteoporosis Int 17 [Suppl 2] :S60
33.
34.
Ström O, Borgstrom F, Zethraeus N, Johnell O et al (2008) Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden. Acta Orthop (accepted)
35.
Oleksik A, Lips P, Dawson A, Minshall ME et al (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392PubMedCrossRef
36.
Odén A, Dawson A, Dere W, Johnell O et al (1998) Lifetime risk of hip fractures is underestimated. Osteoporos Int 8:599–603PubMedCrossRef
37.
Johnell O, Kanis JA, Odén A, Sernbo I et al (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42PubMedCrossRef
38.
Parker MJ, Anand JK (1991) What is the true mortality of hip fractures? Public Health 105:443–446PubMedCrossRef
39.
Kanis JA, Odén A, Johnell O, De Laet C et al (2003) The components of excess mortality after hip fracture. Bone 32:468–473PubMedCrossRef
40.
Cauley JA, Thompson DE, Ensrud KC, Scott JC et al (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561PubMedCrossRef
41.
Zethraeus N, Borgstrom F, Strom O, Kanis JA et al (2007) Cost-effectiveness of the treatment and prevention of osteoporosis—a review of the literature and a reference model. Osteoporos Int 18:9–23PubMedCrossRef
42.
43.
Van den Boogaard CH, Breekveldt-Postma NS, Borggreve SE, Goettsch WG et al (2006) Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study. Curr Med Res Opin 22:1757–1764PubMedCrossRef
44.
Gujarati DN (1995) Basic econometrics. McGraw Hill, Singapore
45.
Kanis JA, Stevenson M, McCloskey EV, Davis S et al (2007) Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 11:1–256
46.
47.
Black DM, Delmas PD, Eastell R, Reid IR et al (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822PubMedCrossRef
48.
Liel Y, Castel H, Bonneh DY (2003) Impact of subsidizing effective anti-osteoporosis drugs on compliance with management guidelines in patients following low-impact fractures. Osteoporos Int 14:490–495PubMedCrossRef
49.
Lillard LA, Rogowski J, Kington R (1999) Insurance coverage for prescription drugs: effects on use and expenditures in the Medicare population. Med Care 37:926–936PubMedCrossRef
50.
Zethraeus N, Stromberg L, Jonsson B, Svensson O et al (1997) The cost of a hip fracture. Estimates for 1,709 patients in Sweden. Acta Orthop Scand 68:13–17PubMedCrossRef
51.
Kanis JA, Johnell O, Odén A, Sembo I et al (2000) Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 11:669–674PubMedCrossRef
52.
Melton LJ III, Gabriel SE, Crowson CS, Tosteson AN et al (2003) Cost-equivalence of different osteoporotic fractures. Osteoporos Int 14:383–388PubMedCrossRef
53.
McCombs JS, Thiebaud P, McLaughlin-Miley C, Shi J (2004) Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 48:271–287PubMedCrossRef
Metadata
Title
Incorporating adherence into health economic modelling of osteoporosis
Authors
O. Ström
F. Borgström
J. A. Kanis
B. Jönsson
Publication date
01-01-2009
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 1/2009
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-008-0644-9

Other articles of this Issue 1/2009

Osteoporosis International 1/2009 Go to the issue

Original Article

Anterior–posterior bending strength at the tibial shaft increases with physical activity in boys: evidence for non-uniform geometric adaptation

Original Article

Global vitamin D levels in relation to age, gender, skin pigmentation and latitude: an ecologic meta-regression analysis

Abstracts IOF World Congress on Osteoporosis 2008

Oral Communication Abstracts

Original Article

Accounting for body size deviations when reporting bone mineral density variables in children

Original Article

Differential regulation of dehydroepiandrosterone and estrogen on bone and uterus in ovariectomized mice

Original Article

Zoledronate reverses mandibular bone loss in osteoprotegerin-deficient mice