Persistence, reproducibility, and cost-effectiveness of an intervention to improve the quality of osteoporosis care after a fracture of the wrist: results of a controlled trial

Abstract

A pragmatic intervention directed at patients and physicians led to substantial improvements in osteoporosis treatment, even when delivered 6-months post-fracture. From the healthcare payer's perspective, the intervention appears to have led to both cost-savings and gains in life expectancy.

Systematic review of the use of bone turnover markers for monitoring the response to osteoporosis treatment: the secondary prevention of fractures, and primary prevention of fractures in high-risk groups

“…184 The remaining eight papers were conducted for western European countries. [185][186][187][188][189][190][191][192] Five studies were conducted by the same authors in Belgium, [188][189][190][191][192] (these are included separately because there were slight variations in the methods used), one was undertaken in the UK, 187 one in Sweden, 185 and one in the Netherlands and the UK.…”

“…The objectives of the studies were to estimate the cost-effectiveness of different treatments for osteoporosis; [186][187][188]190 to model adherence or persistence to treatments of osteoporosis; 182,183,185,189,191,192 to model the cost-effectiveness of a multifaceted intervention to improve osteoporotic care by encouraging patients to come forward and receive treatment after fracture of the wrist; 184 and to evaluate different follow-up regimes for antiresorptive treatments for post-menopausal women with osteoporosis.…”

“…[183][184][185][187][188][189][190][191][192] In Chapter 3 (see Assessment of clinical effectiveness) we adopted standard definitions for adherence, compliance and persistence owing to variation in their use. Persistence is the time until discontinuation of medication, compliance is the proportion of medication taken, and adherence is a combination of persistence and compliance.…”

“…167,[182][183][184][185][187][188][189][190][191][192] A definition of 'primary non-adherence' was also mentioned in two studies and was used to describe the situation where patients were prescribed a drug but never had the prescription filled.…”

“…In another study, 1-year persistence was 80% and this was assumed to continue for the next 4 years. 184 In one study, there was a probability of discontinuation every 3-month period, and patients were permitted to reinitiate treatment (but there was no apparent switching to a different treatment). 182 In one other study, persistence was assumed to be 50% over the duration of treatment.…”