Real-world persistence and adherence with oral bisphosphonates for osteoporosis: a systematic review

Fatoye, Francis; Smith, P.; Yeowell, Gillian

doi:10.1136/bmjopen-2018-027049

Cited by 116 publications

(116 citation statements)

References 109 publications

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“…The currently available data on adherence and persistence to osteoporosis medications have several limitations. First, the available data was mostly self-reported, introducing social desirability and recall bias, or may not be true values due to the use of prescription data and time until last prescription refill [ 6 ]. In addition, this resulted also in an increased risk of bias of missing outcome data.…”

Section: Discussionmentioning

confidence: 99%

“…Osteoporosis medications have shown to be effective in fracture risk reduction [ 3 ]; however, it is well known that adherence to osteoporosis medications is poor and suboptimal, varying from 34 to 75% in the first year of treatment [ 4 , 5 ]. Persistence levels at 1 year were estimated between 18 and 75% [ 6 ]. This suboptimal adherence and persistence leads to increased fracture rate (up to 30%) and worse health outcomes (more subsequent fractures, lower quality of life, and higher mortality), substantially deteriorating the cost-effectiveness resulting from these medications [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Interventions to improve adherence to anti-osteoporosis medications: an updated systematic review

et al. 2020

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Summary An earlier systematic review on interventions to improve adherence and persistence was updated. Fifteen studies investigating the effectiveness of patient education, drug regimen, monitoring and supervision, and interdisciplinary collaboration as a single or multi-component intervention were appraised. Multicomponent interventions with active patient involvement were more effective. Introduction This study was conducted to update a systematic literature review on interventions to improve adherence to anti-osteoporosis medications. Methods A systematic literature review was carried out in Medline (using PubMed), Embase (using Ovid), Cochrane Library, Current Controlled Trials, ClinicalTrials.gov , NHS Centre for Review and Dissemination, CINHAL, and PsycINFO to search for original studies that assessed interventions to improve adherence (comprising initiation, implementation, and discontinuation) and persistence to anti-osteoporosis medications among patients with osteoporosis, published between July 2012 and December 2018. Quality of included studies was assessed. Results Of 585 studies initially identified, 15 studies fulfilled the inclusion criteria of which 12 were randomized controlled trials. Interventions were classified as (1) patient education ( n = 9), (2) drug regimen ( n = 3), (3) monitoring and supervision ( n = 2), and (4) interdisciplinary collaboration ( n = 1). In most subtypes of interventions, mixed results on adherence (and persistence) were found. Multicomponent interventions based on patient education and counseling were the most effective interventions when aiming to increase adherence and/or persistence to osteoporosis medications. Conclusion This updated review suggests that patient education, monitoring and supervision, change in drug regimen, and interdisciplinary collaboration have mixed results on medication adherence and persistence, with more positive effects for multicomponent interventions with active patient involvement. Compared with the previous review, a shift towards more patient involvement, counseling and shared decision-making, was seen, suggesting that individualized solutions, based on collaboration between the patient and the healthcare provider, are needed to improve adherence and persistence to osteoporosis medications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Interventions to improve adherence to anti-osteoporosis medications: an updated systematic review

et al. 2020

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“…Persistence has been shown to have the most influence on cost-effectiveness [ 40 ]. Real-world persistence data with oral bisphosphonates were derived from a recent systematic review suggesting that the mean persistence was 53% at 6 months, 46% at 1 year, 37% at 2 years and 31% at 3 years [ 41 ]. For patients who stopped taking their therapy, the treatment cost immediately stopped and the offset (assumed as a period similar to duration on therapy) period started at the same time.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of FRAX®-based intervention thresholds for management of osteoporosis in Singaporean women

et al. 2020

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Cost-effectiveness analysis of FRAX® intervention thresholds (ITs) in Singaporean women > 50 years of age showed that generic alendronate was cost-effective at age-dependent major osteoporotic fracture (MOF) IT from the ages of 65 years for both full and real-world adherence whilst hip fracture (HF) ITs were cost-effective from the ages of 60 and 65 years. Alendronate was cost-effective irrespective of age only at fixed MOF IT of 14% and HF IT of 3.5%. Introduction FRAX®-based intervention thresholds (ITs) were recently identified for osteoporosis management in Singapore. This study aimed to assess the cost-effectiveness of ITs in Singaporean women over the age of 50 years. Methods A validated Markov microsimulation model was used to estimate the lifetime healthcare costs (SGD2019) per qualityadjusted life-years (QALY) of generic alendronate compared with no treatment. Cost-effectiveness of age-dependent FRAX® major osteoporotic fracture (MOF) and hip fracture (HF) ITs was explored. In addition, ITs that would lead to cost-effectiveness were computed. Fracture incidence and cost data were obtained from the Ministry of Health and a previously published Singaporean study. A cost-effectiveness threshold of SGD 62,500/QALY gained was used, based conservatively on 0.7 times the Singapore GDP per capita. Results Generic alendronate was shown to be cost-effective at MOF ITs from the ages of 65 years, while HF ITs were costeffective from the ages of 60 and 65 years, assuming full and real-world adherence, respectively. A 14% MOF and a 3.5% HF ITs were required for alendronate to be cost-effective above 50 years. Conclusion This study suggests that the treatment of Singaporean women with alendronate is cost-effective at age-dependant FRAX® intervention thresholds at 65 years and older. Furthermore, identifying women at any age above 50 years with a 10-year risk of MOF or HF of 14% or 3.5% would lead to efficient use of resources. Cost-effective access to therapy for patients at high fracture probability based on FRAX® could contribute to reduce the growing burden of osteoporotic fractures in Singapore.

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“…Multiple meta-analyses and systematic reviews have shown that bisphosphonates are effective in decreasing the risk of various types of bone fractures ( Feng et al, 2013 ; Brown et al, 2014 ). However, it is widely acknowledged that compliance (the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen) and persistence (duration of time from initiation to discontinuation of the therapy) with oral osteoporosis medications are poor ( Imaz et al, 2010 ; Hiligsmann et al, 2012a ; Hiligsmann et al, 2012b ; Fatoye et al, 2019 ). A recent observational study estimated that 53% of the study population achieved a medication possession ratio (MPR) of 80% or higher 6 months after initiating therapy, and the equivalent value for 7–12 months was only 43% ( Kothawala et al, 2007 ).…”

Section: Introductionmentioning

confidence: 99%

Economic Evaluation of Oral Alendronate Therapy for Osteoporosis in Chinese Postmenopausal Women: The Impact of Medication Compliance and Persistence

You

Liu

2020

Front. Pharmacol.

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Objective: Prevalence of osteoporosis in Chinese postmenopausal women has significantly increased over the past decade and oral bisphosphonates are the most potent antiresorptive drugs. The purpose of the present research was to evaluate the cost-effectiveness of oral alendronate for individuals with osteoporosis. We also assessed the impact of medication compliance and persistence on economic outcomes of alendronate and potential economic evaluations of persistence-enhancing interventions.Methods: We constructed an individual-level state-transition model to project health outcomes and costs of oral alendronate for Chinese postmenopausal osteoporotic women. The impact of medication compliance and persistence on economic evaluation was addressed in various scenario analyses. Model inputs were derived from clinical trials and published sources, where available. Deterministic and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties and assumptions on the cost-effectiveness results.Results: Compared with no treatment, alendronate treatment was associated with an additional 0.052 QALYs (quality-adjusted life-years) at an additional cost of USD 738, which yielded an incremental cost-effectiveness ratio (ICER) of USD 14,192.308/QALY. The ICER for the different scenarios (full compliance, full persistence, and both full persistence and full compliance) was USD 4,933.333/QALY, USD 3,006.849/QALY, and USD 2,049.822/QALY, respectively. One-way sensitivity analysis showed the ICER was most sensitive to variations in time horizon and residual effect. Probabilistic sensitivity analysis demonstrated that, at a willingness to pay of USD 29,340/QALY, the probability that oral alendronate therapy will be cost-effective is approximately 80%.Conclusion: The findings support the view that oral alendronate is cost-effective for the treatment of osteoporotic fractures in Chinese postmenopausal women. Medication persistence is found to have a greater impact on cost-effectiveness than compliance and interventions to improve persistence to be an efficient use of resources.

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Real-world persistence and adherence with oral bisphosphonates for osteoporosis: a systematic review

Cited by 116 publications

References 109 publications

Interventions to improve adherence to anti-osteoporosis medications: an updated systematic review

Interventions to improve adherence to anti-osteoporosis medications: an updated systematic review

Cost-effectiveness of FRAX®-based intervention thresholds for management of osteoporosis in Singaporean women

Economic Evaluation of Oral Alendronate Therapy for Osteoporosis in Chinese Postmenopausal Women: The Impact of Medication Compliance and Persistence

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