Comparison of Osteoporosis Pharmacotherapy Fracture Rates: Analysis of a MarketScan® Claims Database Cohort

Reynolds, Alan W; Liu, Guodong; Kocis, Paul T; Skowronski, Jenna; Leslie, Douglas L.; Fox, Edward J.

doi:10.5812/ijem.12104

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…Overall, the incidence of fractures more than doubled in patients ≥ 65 versus < 65 years old. In general, the lower rates of fractures observed in the present study compared to previously published results from observational studies are consistent with the relatively young age of the studied population [24][25][26]. Indeed, in a study using claims data from commercially insured patients (all patients < 65 years old; mean age: 56.0 years old), the authors estimated incidence rates of fractures at any site between 15.4 and 16.1 per 1,000 patient-years for bisphosphonates [25].…”

Section: Discussionsupporting

confidence: 93%

“…Indeed, in a study using claims data from commercially insured patients (all patients < 65 years old; mean age: 56.0 years old), the authors estimated incidence rates of fractures at any site between 15.4 and 16.1 per 1,000 patient-years for bisphosphonates [ 25 ]. In a similar study using claims from Medicare insured patients (all patients ≥ 65 years old; mean age, 78.2 years old), the authors estimated at 56.3 per 1,000 patient-years the incidence rate of fractures at any site [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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Fracture rates and economic outcomes in patients with osteoporosis prescribed risedronate gastro-resistant versus other oral bisphosphonates: a claims data analysis

Thomasius¹,

Palacios

Alam³

et al. 2021

Osteoporos Int

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Patients with osteoporosis prescribed risedronate gastro-resistant had a lower incidence of fractures versus those prescribed other oral bisphosphonates. Administration of risedronate gastric-resistant does not require fasting, and this more convenient dosing administration may explain its improved efficacy. Purpose Up to half of patients do not follow complex dosing instructions of immediate-release bisphosphonates used for the prevention of osteoporotic fractures, which can result in suboptimal effectiveness. Risedronate gastro-resistant (GR) offers a more convenient dosing option by eliminating the need for fasting. This study compares fracture rates and outcomes between osteoporosis women treated with risedronate GR (GR cohort) versus other oral bisphosphonates (other cohort). Methods Claims from women with osteoporosis in the USA were analyzed. Patients were classified into the two cohorts based on the first oral bisphosphonate observed (index date) and matched 1:1 based on patient characteristics. Patients were observed for ≥ 2 years following the index date. Fracture rates, health care resource utilization and costs, and treatment persistence were compared. Results In total, 2,726 patients were selected in each cohort (median age: 60.0 years). The incidence of fractures was lower in the GR versus the other cohort for any fracture sites (incidence rate ratio, 95% CI: 0.83, 0.70-0.97) and spine fractures (0.71, 0.54-0.95), although the respective rate of medication discontinuation at 2 years was 80.5% and 74.4%. Time to first fracture was delayed for the GR cohort, reaching statistical significance after 36 months. The GR cohort incurred fewer hospitalizations (incidence rate per 1,000 patient-years: GR = 106.74; other = 124.20, p < 0.05) translating into lower hospitalization costs per patient per year

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Fracture rates and economic outcomes in patients with osteoporosis prescribed risedronate gastro-resistant versus other oral bisphosphonates: a claims data analysis

Thomasius¹,

Palacios

Alam³

et al. 2021

Osteoporos Int

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“…However, given this was a noninferiority trial powered for a different primary outcome [9], the study did not have sufficient power to detect significant differences in fracture rates. While head-to-head comparisons of GR risedronate versus IR risedronate or alendronate are lacking, our estimates are roughly aligned with estimates from studies that reported fracture rates for oral bisphosphonates (the unadjusted risks for any fracture were 50.6-66.8 fracture events per 1000 women-years in the current sample vs. 15-81 fracture events per 1000 women-years in other studies [6,[34][35][36][37][38]; unadjusted risks for site-specific fractures: 3.4-27.4 vs. 3-14 fracture events per 1000 womenyears, respectively [34,38]).…”

Section: Discussionsupporting

confidence: 78%

Fracture risk in women with osteoporosis initiated on gastro-resistant risedronate versus immediate release risedronate or alendronate: a claims data analysis in the USA

Eisman

Cortet²,

Boolell³

et al. 2023

Osteoporos Int

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The study results indicate that women with osteoporosis initiated on gastro-resistant risedronate have a lower risk of fracture than those initiated on immediate release risedronate or alendronate. A large proportion of women discontinued all oral bisphosphonate therapies within 1 year of treatment start. Purpose Using a US claims database (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019), we compared risk of fractures between women with osteoporosis initiated on gastro-resistant (GR) risedronate and those initiated on (a) immediate release (IR) risedronate or (b) immediate release alendronate. Methods Women aged ≥ 60 years with osteoporosis who had ≥ 2 oral bisphosphonate prescription fills were followed for ≥ 1 year after the first observed bisphosphonates dispensing (index date). Fracture risk was compared between the GR risedronate and IR risedronate/alendronate cohorts using adjusted incidence rate ratios (aIRRs), both overall and in subgroups with high fracture risk due to older age or comorbidity/medications. Site-specific fractures were identified based on diagnosis codes recorded on medical claims using a claims-based algorithm. Persistence on bisphosphonate therapy was evaluated for all groups. Results aIRRs generally indicated lower fracture risk for GR risedronate than IR risedronate and alendronate. When comparing GR risedronate to IR risedronate, statistically significant aIRRs (p < 0.05) were observed for pelvic fractures in the full cohorts (aIRRs = 0.37), for any fracture and pelvic fractures among women aged ≥ 65 years (aIRRs = 0.63 and 0.41), for any fracture and pelvic fractures among women aged ≥ 70 years (aIRRs = 0.69 and 0.24), and for pelvic fracture among high-risk women due to comorbidity/medications (aIRR = 0.34). When comparing GR risedronate to alendronate, statistically significant aIRRs were observed for pelvic fractures in the full cohorts (aIRR = 0.54), for any fracture and wrist/arm fractures among women aged ≥ 65 years (aIRRs = 0.73 and 0.63), and for any fracture, pelvic, and wrist/arm fractures among women aged ≥ 70 years (aIRRs = 0.72, 0.36, and 0.58). In all cohorts, ~ 40% completely discontinued oral bisphosphonates within 1 year. Conclusions Discontinuation rates of oral bisphosphonate therapy were high. However, women initiated on GR risedronate had a significantly lower risk of fracture for several skeletal sites than women initiated on IR risedronate/alendronate, particularly those aged ≥ 70 years.

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“…This database has been used extensively in the field of orthopaedics in analyses of costs and spending. 3 , 19 , 25 …”

Section: Methodsmentioning

confidence: 99%

Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis

Ochuba,

Murdock,

et al. 2024

Foot & Ankle Orthopaedics

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Background: Lisfranc fracture-dislocation is an uncommon but serious injury that currently lacks universal consensus on optimal operative treatment. Two common fixation methods are open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The objective of this study is to analyze the cost difference between ORIF and PA of Lisfranc injuries, along with the contribution of medical services to overall costs. Methods: This was a retrospective cost analysis of the MarketScan database from 2010 to 2020. MarketScan is an insurance and commercial claims database that integrates deidentified patient information. It captures person-specific clinical utilization, expenditures, and enrollment across inpatient and outpatient services. Patients undergoing primary ORIF ( CPT code 28615) vs PA (28730 and 28740) for Lisfranc fracture-dislocation were identified. The primary independent variable was ORIF vs PA of Lisfranc injury. Total costs due to operative management was the primary objective. The utilization of and costs contributed by medical services was a secondary outcome. Results: From 2010 to 2020, a total of 7268 patients underwent operative management of Lisfranc injuries, with 5689 (78.3%) ORIF and 1579 (21.7%) PA. PA was independently associated with increased net and total payment and coinsurance, clinic visits, and imaging, and patients attended significantly more PT sessions. Conclusion: Using this large database that does not characterize severity or extent of injury, we found that treatment of Lisfranc fracture-dislocation with ORIF was associated with substantially lower initial episode of treatment costs compared with PA. Specific excessive cost drivers for PA were clinic visits, PT sessions, and imaging. Level of Evidence: Level III, retrospective cohort study.

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Comparison of Osteoporosis Pharmacotherapy Fracture Rates: Analysis of a MarketScan® Claims Database Cohort

Cited by 5 publications

References 26 publications

Fracture rates and economic outcomes in patients with osteoporosis prescribed risedronate gastro-resistant versus other oral bisphosphonates: a claims data analysis

Fracture rates and economic outcomes in patients with osteoporosis prescribed risedronate gastro-resistant versus other oral bisphosphonates: a claims data analysis

Fracture risk in women with osteoporosis initiated on gastro-resistant risedronate versus immediate release risedronate or alendronate: a claims data analysis in the USA

Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis

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