The Association of Adherence to Osteoporosis Therapies with Fracture, All-Cause Medical Costs, and All-Cause Hospitalizations: A Retrospective Claims Analysis of Female Health Plan Enrollees with Osteoporosis

Halpern, Rachel; Becker, Laura; Iqbal, Sheikh Usman; Kazis, Lewis E.; Macarios, David; Badamgarav, Enkhjargal

doi:10.18553/jmcp.2011.17.1.25

Cited by 88 publications

(63 citation statements)

References 17 publications

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“…However, charges have been criticized because they do not reflect real costs 77 and they do not take into account the various levels of co-payment, deductibles, and co-insurances. As observed in other chronic conditions, 78,79 hospitalization is a substantial cost driver of non-adherence. However, it is not clear if this result is driven by the inclusion of more severe or advanced patients with CML in the studies.…”

Section: © F E R R a T A S T O R T I F O U N D A T I O Nmentioning

confidence: 80%

Measurement of adherence to BCR-ABL inhibitor therapy in chronic myeloid leukemia: current situation and future challenges

et al. 2014

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Correspondence: Lucien.Noens@uzgent.be BCR-ABL inhibitors for treating chronic myeloid leukemia in chronic phase have transformed a previously incurable malignancy into a manageable condition. However, suboptimal medication adherence has been observed with these agents affecting clinical outcomes and healthcare costs. In order to raise awareness of the problem of adherence, and before developing pragmatic strategies to enhance medication adherence, a deep understanding of the best approaches for measuring adherence in chronic myeloid leukemia patients and identifying non-adherence is required. A systematic literature review on the prevalence, measurement methods, consequences and risk factors for non-adherence to BCR-ABL inhibitors and adherence-enhancing interventions was performed and critically appraised. Of the 19 included articles, 9 were retrospective. Average adherence varied from 19% to almost 100% of the proportion of prescribed drug taken, but it was measured through various different methods and within different study groups. Suboptimal adherence was associated with a negative impact on both clinical and economic outcomes. There is a lack of supportive evidence demonstrating a difference in adherence across BCR-ABL inhibitors and even contradictory results between the 2 nd generation inhibitors. Drug-related adverse events and forgetfulness were common reasons for intentional and unintentional non-adherence, respectively, but further research is required to identify additional reasons behind non-adherence or patients at risk of non-adherence. Non-adherence in chronic myeloid leukemia patients treated with BCR-ABL inhibitors is common and associated with critical outcomes. However, this review highlights important existing gaps, reveals inconsistent definitions, and a lack of standardized methods for measuring adherence in chronic myeloid leukemia. All require further investigation. ABSTRACT © F e r r a t a S t o r t i F o u n d a t i o nAnalyses statement for systematic reviews. 16 Publication database (EMBASE, PubMed, and Cochrane Library) specific search terms consisted of both single and MeSH terms for the disease, adherence and BCR-ABL inhibitor therapy (Online Supplementary Table S1). The last search was conducted on December 20 th , 2011. Full-text references were provided for the eligible abstracts that were published after completion of the search process and the analyses. In addition, and due to the lack of existing evidence of adherence in CML, clinical and economic conference proceedings were also searched with a time limit of three years. Preliminary inclusion (or exclusion) of a specific study or conference abstract was based on review of the title and abstract by 2 independent reviewers against pre-specified criteria (Table 1). Final inclusion of the study was based on an in-depth review of the full manuscript. Multiple variables were extracted from the articles to answer study objectives (Online Supplementary Table S2). The analysis was descriptive only. Since abstracts in conference pr...

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Section: © F E R R a T A S T O R T I F O U N D A T I O Nmentioning

confidence: 80%

Measurement of adherence to BCR-ABL inhibitor therapy in chronic myeloid leukemia: current situation and future challenges

et al. 2014

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“…20,21 The database used for this analysis includes enrollment information and medical and pharmacy claims from July 1, 2001, through June 30, 2010. Of the patients in this database, the study cohorts were drawn from approximately 50 million patients who had both pharmacy and medical coverage.…”

Section: ■■ Methods Study Design and Data Sourcementioning

confidence: 99%

All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective

McAdam‐Marx

McGarry

Hane³

et al. 2011

JMCP

149

126

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• Annual total direct and indirect costs related to infections with the hepatitis C virus (HCV) in the United States were estimated at $5.46 billion in 1997. Davis et al. (2011) estimated that all-cause health care costs for managed care organization (MCO) enrollees with HCV were $20,961 per patient per year (PPPY), of which $6,864 PPPY was HCV-related, from 2002 through 2006.• The burden of illness for HCV is predicted to grow over the next 2 decades, partly due to increased prevalence of advanced liver disease (AdvLD) in the current HCV population. What is already known about this subjectAll-Cause and METHODS: This retrospective, matched cohort study included patients aged at least 18 years and with at least 6 months of continuous enrollment in a large managed care organization (MCO) claims database from July 1, 2001, through March 31, 2010. Patients with a diagnosis of HCV (ICD-9-CM codes 070.54, 070.70) were identified and stratified into those with and without AdvLD, defined as decompensated cirrhosis (ICD-9-CM codes 070. 44, 070.71, 348.3x, 456.0, 456.1, 456.2x, 572.2, 572.3, 572.4, 782.4, 789.59); hepatocellular carcinoma (HCC, ICD-9-CM code 155); or liver transplant (ICD-9-CM codes V42.7, 50.5 or CPT codes 47135, 47136). For patients without AdvLD, the index date was the first HCV diagnosis date observed at least 6 months after the first enrollment date, and at least 6 months of continuous enrollment after the index date were required. HCV patients without AdvLD were stratified into those with and without compensated cirrhosis (ICD-9-CM codes 571.2, 571.5, 571.6). For patients with AdvLD, the index date was the date of the first AdvLD diagnosis observed at least 6 months after the first enrollment date, and at least 1 day of enrollment after the index date was required. Cases were matched in an approximate 1:10 ratio to comparison patients without an HCV diagnosis or AdvLD diagnosis who met all other inclusion criteria based on gender, age, hospital referral region state, pre-index health care costs, alcoholism, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and a modified Charlson Comorbidity Index. For the HCV and comparison patient cohorts, PPPY all-cause costs to the payer were calculated as total allowed charges summed across all patients divided by total patient-days of follow-up for the cohort, multiplied by 365, inflation-normalized to 2009 dollars. Because the calculation of PPPY cost generated a single value for each cohort, bootstrapping was used to generate descriptive statistics. Incremental PPPY costs for HCV patients relative to non-HCV patients were calculated as between-group differences in PPPY costs. T-tests for independent samples were used to compare costs between case and comparison cohorts.RESULTS: A total of 34,597 patients diagnosed with HCV, 78.0% with HCV without AdvLD, 4.4% with compensated cirrhosis, 12.3% with decompensated cirrhosis, 2.8% with HCC, and 2.6% with liver transplant, were matched to 330,435 comparison patients. Mean (SD) age of al...

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“…Several observational studies have recently been published for the bisphosphonates; however, differences in study populations, methodology, and outcomes measured make it difficult to compare the effectiveness of the medications and claims of superiority of one drug over another. [10][11][12][13][14][15][16] For health plans and other decision makers, having a complete picture of how the medication is actually used and the resulting outcomes may prove useful and increase the likelihood of making the most appropriate coverage decisions. Given the lack of headto-head RCTs and the limitations of published observational studies of oral bisphosphonates, a health plan-sponsored retrospective analysis of administrative claims was designed to determine if there were differences among oral bisphosphonate agents in their effectiveness as measured by adherence, fracture rates, or total cost of care in a large managed care population.…”

Section: What Is Already Known About This Subjectmentioning

confidence: 99%

“…12 Low adherence has been associated with both higher risk of fracture and higher costs. 13,14,16 For instance, in the analysis by Halpern et al (2011), commercially insured women with low adherence (MPR < 80%) had 37% higher fracture risk and 12% higher all-cause medical costs through 18 months of follow-up compared with women with higher adherence (MPR > 80%). 16 The differences in methodology of these and other studies make it difficult to compare their results with ours.…”

Section: Analysis Of the Comparative Effectiveness Of 3 Oral Bisphospmentioning

confidence: 99%

“…A recent analysis by Halpern et al (2011) showed that low adherence (medication possession ratio [MPR] < 80%) was associated with 37% higher fracture risks and 12% higher all-cause medical costs. However, there is a lack of comparative effectiveness data for adherence, fracture rates, and total cost of care among the 3 commonly used oral bisphosphonates (alendronate, risedronate, and ibandronate) for a period longer than 12-18 months.…”

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confidence: 99%

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Analysis of the Comparative Effectiveness of 3 Oral Bisphosphonates in a Large Managed Care Organization: Adherence, Fracture Rates, and All-Cause Cost

Martin

Yu²,

Campbell³

et al. 2011

JMCP

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• Randomized, controlled trials (RCTs) of oral bisphosphonates have shown statistically significant reductions in fracture rates versus placebo, but whereas alendronate and risedronate have shown reductions in vertebral and nonvertebral fractures, ibandronate has been shown to reduce vertebral fractures only. Comparison of fracture rates among the bisphosphonates is difficult due to the lack of head-to-head RCTs designed to compare this outcome.• Several observational studies regarding osteoporosis therapy have been published. A recent analysis by Halpern et al. (2011) showed that low adherence (medication possession ratio [MPR] < 80%) was associated with 37% higher fracture risks and 12% higher all-cause medical costs. However, there is a lack of comparative effectiveness data for adherence, fracture rates, and total cost of care among the 3 commonly used oral bisphosphonates (alendronate, risedronate, and ibandronate) for a period longer than 12-18 months. What is already known about this subject

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The Association of Adherence to Osteoporosis Therapies with Fracture, All-Cause Medical Costs, and All-Cause Hospitalizations: A Retrospective Claims Analysis of Female Health Plan Enrollees with Osteoporosis

Cited by 88 publications

References 17 publications

Measurement of adherence to BCR-ABL inhibitor therapy in chronic myeloid leukemia: current situation and future challenges

Measurement of adherence to BCR-ABL inhibitor therapy in chronic myeloid leukemia: current situation and future challenges

All-Cause and Incremental Per Patient Per Year Cost Associated with Chronic Hepatitis C Virus and Associated Liver Complications in the United States: A Managed Care Perspective

Analysis of the Comparative Effectiveness of 3 Oral Bisphosphonates in a Large Managed Care Organization: Adherence, Fracture Rates, and All-Cause Cost

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