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Potential Clinical and Economic Impact of Nonadherence with Osteoporosis Medications

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Abstract

This study aims to estimate the potential clinical and economic implications of therapeutic adherence to bisphosphonate therapy. A validated Markov microsimulation model was used to estimate the impact of varying adherence to bisphosphonate therapy on outcomes (the number of fractures and the quality-adjusted life-years [QALYs]), health-care costs, and the cost-effectiveness of therapy compared with no treatment. Adherence was divided into persistence and compliance, and multiple scenarios were considered for both concepts. Analyses were performed for women aged 65 years with a bone mineral density T-score of −2.5. Health outcomes and the cost-effectiveness of therapy improved significantly with increasing compliance and/or persistence. In the case of real-world persistence and with a medical possession ratio (MPR; i.e., the number of doses taken divided by the number of doses prescribed) of 100%, the QALY gain and the number of fractures prevented represented only 48 and 42% of the values estimated assuming full persistence, respectively. These proportions fell to 27 and 23% with an MPR value of 80%. The costs per QALY gained, for branded bisphosphonates (and generic alendronate), were estimated at €19,069 (€4,871), €32,278 (€11,985), and €64,052 (€30,181) for MPR values of 100, 80, and 60%, respectively, assuming real-world persistence. These values were €16,997 (€2,215), €24,401 (€6,179), and €51,750 (€20,569), respectively, assuming full persistence. In conclusion, poor compliance and failure to persist with osteoporosis medications results not only in deteriorating health outcomes, but also in a decreased cost-effectiveness of drug therapy. Adherence therefore remains an important challenge for health-care professionals treating osteoporosis.

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Acknowledgments

This study was supported by an unrestricted educational grant from Novartis Pharmaceuticals. The funding agency had no role in the design and conduct of the study, the collection, management, analysis, and interpretation of the data, the preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication. The development and validation of the model were previously supported by an ESCEO-Amgen Fellowship grant received at the Sixth European Congress on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (Vienna, 2006).

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Authors and Affiliations

  1. HEC-ULg Management School, University of Liège, Boulevard du Rectorat 7, Bât. B31, 4000, Liège, Belgium

    Mickaël Hiligsmann & Henry-Jean Gathon

  2. Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium

    Mickaël Hiligsmann, Véronique Rabenda, Olivier Ethgen & Jean-Yves Reginster

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  1. Mickaël Hiligsmann
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  2. Véronique Rabenda
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  5. Jean-Yves Reginster
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Correspondence to Mickaël Hiligsmann.

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Hiligsmann, M., Rabenda, V., Gathon, HJ. et al. Potential Clinical and Economic Impact of Nonadherence with Osteoporosis Medications. Calcif Tissue Int 86, 202–210 (2010). https://doi.org/10.1007/s00223-009-9329-4

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  • DOI: https://doi.org/10.1007/s00223-009-9329-4

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