Top

Osteoporosis International

Published in:

01-09-2009 | Original Article

Adherence to weekly oral bisphosphonate therapy: cost of wasted drugs and fractures

Authors: O. Sheehy, C. Kindundu, M. Barbeau, J. LeLorier

Published in: Osteoporosis International | Issue 9/2009

Abstract

Summary

In an observational cohort of patients treated with biphosphonates (BP), we observed that poor adherence to these drugs causes important expenditures in terms of avoidable fractures. Of particular interest are the amounts of money wasted by patients who did not take their BPs long enough to obtain a clinical benefit.

Introduction

A large proportion of patients initiated with oral weekly BP therapy stop their treatment within the first year. The objective of this study was to estimate the impact of the poor adherence to BPs in terms of drug wasted and avoidable fractures.

Methods

The study was done on primary and secondary prevention cohorts from the Régie de l’assurance maladie du Québec (Québec). The concept of the “point of visual divergence” was used to determine the amount of wasted drug. The risk of fracture was estimated using Cox regression models. The hazard ratios of compliant patients (+80%) versus non compliant patients were used to estimate the number of fractures saved.

Results

The cost of wasted drugs was $25.87 per patient initiated in the primary prevention cohort and $30.52 in the secondary prevention cohort. If all patients had been compliant, 110 fractures would have been avoided in the primary prevention cohort and 19 fractures in the secondary prevention cohort. The cost of these avoidable fractures per patient initiated on BP therapy was $62.95 in primary prevention cohort and $330.84 in secondary prevention cohort.

Conclusions

This study confirms that poor adherence to oral BPs leads to a significant waste of money and avoidable fractures.

Available only for authorised users

Osteoporosis Canada 2007 (2007) 2006–2007 Annual Review (Report)

Brown JP, Fortier M, Frame H, Lalonde A, Papaioannou A, Senikas V, Yuen CK (2006) Canadian consensus conference on osteoporosis, 2006 update. J Obstet Gynaecol Can 28(2 Suppl 1):S95–S112PubMed

Lorrain J, Paiement G, Chevrier N, Lalumiere G, Laflamme GH, Caron P, Fillion A (2003) Population demographics and socioeconomic impact of osteoporotic fractures in Canada. Menopause 10(3):228–234PubMedCrossRef

Lindsay R, Burge RT, Strauss DM (2005) One year outcomes and costs following a vertebral fracture. Osteoporos Int 16(1):78–85PubMedCrossRef

Colon-Emeric CS, Caminis J, Suh TT, Pieper CF, Janning C, Magaziner J, Adachi J, Rosario-Jansen T, Mesenbrink P, Horowitz ZD, Lyles KW (2004) The HORIZON Recurrent Fracture Trial: design of a clinical trial in the prevention of subsequent fractures after low trauma hip fracture repair. Curr Med Res Opin 20(6):903–910PubMedCrossRef

ISPOR (2003) Health care cost, quality, and outcomes

Blouin J, Dragomir A, Ste-Marie LG, Fernandes JC, Perreault S (2007) Discontinuation of antiresorptive therapies: a comparison between 1998–2001 and 2002–2004 among osteoporotic women. J Clin Endocrinol Metab 92(3):887–894PubMedCrossRef

Cramer JA, Gold DT, Silverman SL, Lewiecki EM (2007) A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 18(8):1023–1031PubMedCrossRef

Downey TW, Foltz SH, Boccuzzi SJ, Omar MA, Kahler KH (2006) Adherence and persistence associated with the pharmacologic treatment of osteoporosis in a managed care setting. South Med J 99(6):570–575PubMedCrossRef

10.

Penning-van Beest FJ, Goettsch WG, Erkens JA, Herings RM (2006) Determinants of persistence with bisphosphonates: a study in women with postmenopausal osteoporosis. Clin Ther 28(2):236–242PubMedCrossRef

11.

Reginster JY, Rabenda V, Neuprez A (2006) Adherence, patient preference and dosing frequency: understanding the relationship. Bone 38(4 Suppl 1):S2–S6PubMedCrossRef

12.

van den Boogaard CH, Breekveldt-Postma NS, Borggreve SE, Goettsch WG, Herings RM (2006) Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study. Curr Med Res Opin 22(9):1757–1764PubMedCrossRef

13.

Weycker D, Macarios D, Edelsberg J, Oster G (2006) Compliance with drug therapy for postmenopausal osteoporosis. Osteoporos Int 17(11):1645–1652PubMedCrossRef

14.

Siris ES, Harris ST, Rosen CJ, Barr CE, Arvesen JN, Abbott TA, Silverman S (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81(8):1013–1022PubMedCrossRef

15.

McCombs JS, Thiebaud P, McLaughlin-Miley C, Shi J (2004) Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 48(3):271–287PubMedCrossRef

16.

Ettinger B, Pressman AR, Schein J (1998) Alendronate use among 812 women: prevalence of gastrointestinal complaints, non-compliance with patient instructions, and discontinuation. J Manag Care Pharm 4:488–492

17.

Lo JC, Pressman AR, Omar MA, Ettinger B (2006) Persistence with weekly alendronate therapy among postmenopausal women. Osteoporos Int 17(6):922–928PubMedCrossRef

18.

Solomon DH, Morris C, Cheng H, Cabral D, Katz JN, Finkelstein JS, Avorn J (2005) Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions. Mayo Clin Proc 80(2):194–202PubMedCrossRef

19.

Bone HG, Hosking D, Devogelaer JP, Tucci JR, Emkey RD, Tonino RP, Rodriguez-Portales JA, Downs RW, Gupta J, Santora AC, Liberman UA (2004) Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 350(12):1189–1199PubMedCrossRef

20.

McClung MR (2000) Bisphosphonates in osteoporosis: recent clinical experience. Expert Opin Pharmacother 1(2):225–238PubMedCrossRef

21.

Lekkerkerker F, Kanis JA, Alsayed N, Bouvenot G, Burlet N, Cahall D, Chines A, Delmas P, Dreiser RL, Ethgen D, Hughes N, Kaufman JM, Korte S, Kreutz G, Laslop A, Mitlak B, Rabenda V, Rizzoli R, Santora A, Schimmer R, Tsouderos Y, Viethel P, Reginster JY (2007) Adherence to treatment of osteoporosis: a need for study. Osteoporos Int 18(10):1311–1317PubMedCrossRef

22.

Rabenda V, Mertens R, Fabri V, Vanoverloop J, Sumkay F, Vannecke C, Deswaef A, Verpooten GA, Reginster JY (2008) Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women. Osteoporos Int 19(6):811–818PubMedCrossRef

23.

Huybrechts KF, Ishak KJ, Caro JJ (2006) Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone 38(6):922–928PubMedCrossRef

24.

Sunyecz JA, Mucha L, Baser O, Barr CE, Amonkar MM (2008) Impact of compliance and persistence with bisphosphonate therapy on health care costs and utilization. Osteoporos Int 19(10):1421–1429PubMedCrossRef

25.

Tamblyn R, Lavoie G, Petrella L, Monette J (1995) The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 48(8):999–1009PubMedCrossRef

26.

Tamblyn R, Reid T, Mayo N, McLeod P, Churchill-Smith M (2000) Using medical services claims to assess injuries in the elderly: sensitivity of diagnostic and procedure codes for injury ascertainment. J Clin Epidemiol 53(2):183–194PubMedCrossRef

27.

Garbe E, Lelorier J, Boivin JF, Suissa S (1997) Risk of ocular hypertension or open-angle glaucoma in elderly patients on oral glucocorticoids. Lancet 350(9083):979–982PubMedCrossRef

28.

Pilon D, Castilloux AM, Dorais M, Lelorier J (2004) Oral anticoagulants and the risk of osteoporotic fractures among elderly. Pharmacoepidemiol Drug Saf 13(5):289–294PubMedCrossRef

29.

Quach C, Collet JP, Lelorier J (2005) Effectiveness of amoxicillin, azithromycin, cefprozil and clarithromycin in the treatment of acute otitis media in children: a population-based study. Pharmacoepidemiol Drug Saf 14(3):163–170PubMedCrossRef

30.

Rahme E, Pettitt D, Lelorier J (2002) Determinants and sequelae associated with utilization of acetaminophen versus traditional nonsteroidal antiinflammatory drugs in an elderly population. Arthritis Rheum 46(11):3046–3054PubMedCrossRef

31.

Rakel A, Sheehy O, Rahme E, Lelorier J (2007) Does diabetes increase the risk for fractures after solid organ transplantation? A nested case–control study. J Bone Miner Res 22:1878–1884PubMedCrossRef

32.

Sikka R, Xia F, Aubert RE (2005) Estimating medication persistency using administrative claims data. Am J Manag Care 11(7):449–457PubMed

33.

Billups SJ, Malone DC, Carter BL (2000) The relationship between drug therapy noncompliance and patient characteristics, health-related quality of life, and health care costs. Pharmacotherapy 20(8):941–949PubMedCrossRef

34.

Recker RR, Gallagher R, MacCosbe PE (2005) Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 80(7):856–861PubMedCrossRef

35.

Cardinal H, Monfared AA, Dorais M, Lelorier J (2006) The concept of the ‘percent wasted patients’ in preventive health strategies. Pharmacoepidemiol Drug Saf 15(1):57–61PubMedCrossRef

36.

Coyle D, Hadj Tahar A, Murphy G (2006) Teriparatide and bisphosphonates for treatment of oesteoporosis in women: a clinical and economic analysis. Canadian Agency for Drugs and Technologies in Health (CADTH). Report Issue 70, 55 (Report)

37.

Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12(4):271–278PubMedCrossRef

38.

Cree M, Soskolne CL, Belseck E, Hornig J, McElhaney JE, Brant R, Suarez-Almazor M (2000) Mortality and institutionalization following hip fracture. J Am Geriatr Soc 48(3):283–288PubMed

39.

Goeree R, O'Brien B, Pettitt D, Cuddy L, Ferraz M, Adachi JD (1996) An assessment of the burden of illness due to osteoporosis in Canada. J Soc Obstet Gynaecol Can 18(Suppl):15–24

40.

Goeree R, Blackhouse G, Adachi J (2006) Cost-effectiveness of alternative treatments for women with osteoporosis in Canada. Curr Med Res Opin 22(7):1425–1436PubMedCrossRef

41.

Statistics Canada (2007) Consumer price index, by province. Internet communication

42.

Von Korff M, Wagner EH, Saunders K (1992) A chronic disease score from automated pharmacy data. J Clin Epidemiol 45(2):197–203CrossRef

43.

Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348(9041):1535–1541PubMedCrossRef

44.

Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, Nevitt MC, Suryawanshi S, Cummings SR (2000) Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab 85(11):4118–4124PubMedCrossRef

45.

Ringer JD (2008) Differences in efficacy and safety of generic and original branded once weekly bisphosphonates in postmenopausal women with osteoporosis. Osteoporosis International 19 [Suppl 1], S24–S25

Title: Adherence to weekly oral bisphosphonate therapy: cost of wasted drugs and fractures
Authors: O. Sheehy
C. Kindundu
M. Barbeau
J. LeLorier
Publication date: 01-09-2009
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 9/2009
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-008-0829-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Adherence to weekly oral bisphosphonate therapy: cost of wasted drugs and fractures

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2009

Comparison of direct health care costs related to the pharmacological treatment of osteoporosis and to the management of osteoporotic fractures among compliant and noncompliant users of alendronate and risedronate: a population-based study

Skeletal and hormonal responses to sunlight deprivation in Antarctic expeditioners

External hip protectors are effective for the elderly with higher-than-average risk factors for hip fractures

Antipsychotic use and the risk of hip/femur fracture: a population-based case–control study

Comment on Kanis et al.: “European guidance for the diagnosis and management of osteoporosis in postmenopausal women”

Long-term follow-up of testicular cancer patients shows no predisposition to osteoporosis