Two-year persistence and compliance with osteoporosis therapies among postmenopausal women in a commercially insured population in the United States

Abstract

SummaryThis retrospective, observational study assessed 2-year persistence and compliance by treatment, route of administration, and dosing frequency in postmenopausal women initiating a new osteoporosis therapy. Two-year persistence and compliance rates were higher in women receiving injectables compared with oral agents.PurposeThis study extends previous studies limited to 1-year follow-up by examining persistence with osteoporosis therapies over a 2-year period and compares short- and long-term trends in persistence and compliance among postmenopausal women with commercial or Medicare supplemental insurance in the USA.MethodsThis retrospective, observational cohort study enrolled women ≥50 years newly initiating osteoporosis therapy between January 1 and December 31, 2012 (i.e., the index date), with continuous enrollment ≥14 months before and ≥24 months after their index date. Persistence (continuous therapy without a >60-day gap) and compliance with the index therapy were evaluated at 2 years of follow-up. Multivariable logistic regression was used to compare the odds of persistence and compliance across treatment and dosing regimens.ResultsThis study included 43,543 patients with mean (standard deviation) age 65 (10) years. At 2 years of follow-up, persistence and compliance were higher for patients treated with injectable agents (ranging from 34 to 41%, excluding an every-3-month injection) than those treated with oral agents (ranging from 20 to 31%). Additionally, patients initiating oral bisphosphonates (except risedronate once daily), raloxifene (daily), or zoledronic acid (annually) had significantly lower odds of persistence compared with denosumab (every 6 months).ConclusionsPatients initiating injectable therapies had greater persistence and compliance at 2 years than those initiating oral therapies. Patients initiating an every-6-month injection had significantly higher persistence compared with those initiating more frequently dosed (e.g., daily and weekly) oral or injectable agents.

Zoledronate for the Prevention of Bone Loss in Women Discontinuing Denosumab Treatment. A Prospective 2-Year Clinical Trial

“…Limitations of our study include the small number of treated women, the open label design, and the relatively short duration of Dmab treatment in ZOL‐treated patients. This duration of treatment is, however, consistent with “real‐world” findings showing adherence to Dmab treatment for 2 years in about 50% of patients in most studies, though higher rates have also been reported . In addition, the relatively small number of patients of our study allowed detailed analysis of individual responses, not generally available in large trials, which provided information important for clinical care.…”

Cost‐Effectiveness of Sequential Teriparatide/Alendronate Versus Alendronate‐Alone Strategies in High‐Risk Osteoporotic Women in the US: Analyzing the Impact of Generic/Biosimilar Teriparatide

“…Persistence and adherence are important factors that influence the outcome of the treatment of osteoporosis, where persistence refers to “the duration of time from initiation to discontinuation of the therapy” and adherence refers to “the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen.” We estimated persistence and adherence rates of alendronate and teriparatide based on Durden and colleagues' recent observational study in the US setting, in which persistence and adherence rates for 12 months and 24 months of teriparatide were higher than those of weekly oral alendronate . These results were consistent with a previous study in Germany, in which 12‐month persistence and adherence rates were higher with daily teriparatide than with weekly alendronate .…”

“…As Murad and colleagues' study did not present the pair-wise OR for wrist fracture, we referred to Freemantle and colleagues' study, (19) which has the second-best AMSTAR score (7 out of 11). Although the 95% CIs of relative risks of teriparatide or alendronate for wrist fracture also crossed 1.0, we also assumed these treatments were efficacious in reducing the risk of wrist fracture in the base case, as the probabilities of relative risk less than 1.0 were (18) Clinical vertebral fracture 0.30 0.16-0.55 Beta (18) Wrist fracture 0.24 0.02-1.0 Triangular (19) Other osteoporotic fracture 0.50 0.32-0.78 Beta (18) Persistence and adherence (%) Persistence, 12 months 63.4 AE50% a Triangular (23) Persistence, 24 months 40.8 AE50% a Triangular (23) Adherence, 12 months 54.4 AE50% a Triangular (23) Adherence, 24 months 39.8 AE50% a Triangular (23) Alendronate Efficacy Hip fracture 0.45 0.27-0.68 Beta (18) Clinical vertebral fracture 0.50 0.33-0.79 Beta (18) Wrist fracture 0.82 0.25-1.0 Triangular (19) Other osteoporotic fracture 0.78 0.66-0.92 Beta (18) Persistence and adherence (%) Persistence, 12 months 38.7 AE50% a Triangular (23) Persistence, 24 months 23.7 AE50% a Triangular (23) Adherence, 12 months 31.3 AE50% a Triangular (23) Adherence, 24 months 22.8 AE50% a Triangular (23) Costs (2018 US dollars) Formal health care sector Alendronate, annual 205 86-324 Triangular (2) Teriparatide, annual 20,161 4005-22,646 b Triangular (2) Physician visit (CPT code 99213) 74 NA NA (33) DXA scan (CPT code 77080) 100 49-150 Triangular (33) Treatment costs Hip fracture 29,986 25,677-42,913 Log-normal (10) Clinical vertebral fracture 8325 5775-15,975 Log-normal (10) Wrist fracture 4577 2543-10,674 Log-normal (10) Other osteoporotic fracture 14,144 10,086-26,314 Log-normal (10) Non-health care sector Annual long-term care after hip fracture 2577 0-5154 Triangular (10) Unpaid lost productivity caused by hip fracture, age 65-69 1690 AE50% a Triangular (36) Unpaid lost productivity caused by hip fracture, age 70-74 1005 AE50% a Triangular (36) ...…”

Cost-Effectiveness of Osteoporosis Screening Using Biomechanical Computed Tomography for Patients With a Previous Abdominal CT

“…Patients who tested positive were classified at high risk and were eligible for 2 years of alendronate treatment, whereas patients who tested negative were not offered any treatment. We assumed that 50% of patients prescribed treatment filled their prescriptions and were 100% adherent to it over a 2‐year duration …”

“…As in other cost‐effectiveness analyses, we assumed 50% of patients who tested positive actually went on treatment . In sensitivity analyses, we used lower (30%) and higher (70%) rates of treatment initiation to assess how that parameter can impact the overall clinical utility and costs.…”