Comparative statistical analysis of osteoporosis treatment based on Hungarian claims data and interpretation of the results in respect to cost-effectiveness

Lakatos, Péter L.; Tóth, Emese; Szekeres, L.; Poór, Gyula; Héjj, Gábor; Marton, I; Takács, István

doi:10.1007/s00198-014-2733-2

Cited by 8 publications

(11 citation statements)

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“…Hence, the investigation of different ways of encouraging patients in the maintenance of a long-term treatment becomes imperative. [ 4 , 5 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 , 3 ] Many studies show that fracture risk in osteoporotic patients may be reduced by 70% with bone protective therapy. [ 4 , 5 ] Even with this favorable result, osteoporosis treatment faces a problem concerning low adherence, the same way that many other silent chronic diseases. [ 6 ] Studies show that adherence has not grown satisfactorily despite the increase in treatment prescription.…”

Section: Introductionmentioning

confidence: 99%

“…[ 15 ] On the other hand, high adherence rate is associated with decreased fracture risk and lower hospitalization and mortality rates. [ 5 , 16 ]…”

Section: Introductionmentioning

confidence: 99%

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Factors related with osteoporosis treatment in postmenopausal women

et al. 2018

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Although fractures had high mortality and morbidity, many studies proved that fracture risk might be decreased by pharmacological therapy, although a low treatment adherence rate is observed. The aim of this study was to identify factors associated with osteoporosis treatment in postmenopausal women.A cross-sectional study was carried out from March to August 2013 at the primary care setting. Postmenopausal women were recruited. A standardized questionnaire was applied. Women who were using at least one of the following drugs at the moment of the survey were considered as current treatment: bisphosphonates, raloxifene, estrogen, calcitonin, teriparatide, or strontium ranelate. Women who had used any of the mentioned medications before the study were considered as past treatment.Of the 1025 women included in the study, 8% were on current treatment, 5.7% had past treatment, and 86.3% had not received treatment. Treated women (either current or past) had a higher rate of osteoarthritis, had more falls, had higher education level, presented a higher rate of private health insurance, and received more information about osteoporosis. They also had more dual-energy x-ray absorptiometry (DXA) scans and were more frequently diagnosed with osteoporosis by these DXA scans. The factors independently associated with treatment in the regression analysis were the DXA scan itself, the diagnosis of osteoporosis by DXA, and information about osteoporosis.Current and past treatments of osteoporosis were associated with DXA and information. These results suggest that some measures to inform women about osteoporosis and or even the popularization of DXA scans could improve the treatment.

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“…Hence, the investigation of different ways of encouraging patients in the maintenance of a long-term treatment becomes imperative. [ 4 , 5 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors related with osteoporosis treatment in postmenopausal women

et al. 2018

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“…Magyarországon is egyre nagyobb figyelem irányul a terápia eredményességének, költséghatékonyságának mé-résére OP-ban [13,24]. Kutatásunk, amely ismereteink szerint elsőként szolgál törésirizikó-adatokat az OP-ellá-tásban gondozott betegekről, ezt kívánta elősegíteni.…”

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A szakellátásban megjelenő osteoporosisos nők 10 éves csonttöréskockázata a FRAX^® alapján

et al. 2016

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Bevezetés: Az osteoporosis-ellátás kulcskérdése a fokozott csonttörési kockázatú betegek azonosítása és kezelése. Cél-kitűzés: A hazai osteoporosis-szakellátásban megjelenő osteoporosisos nők törési kockázatának felmérése. Módszer: A szerzők keresztmetszeti kérdőíves vizsgálatot végeztek 2009-ben 11 osteoporosis-centrumban ≥50 éves osteoporosisos nőbetegek körében. Felmérték a főbb törési kockázati tényezőket, a FRAX ® kalkulátor magyarországi válto-zatával kiszámolták a 10 éves törési kockázatot. Az egészségi állapotot EQ VAS-sal vizsgálták. Eredmények: Az 1301 beteg átlagéletkora 68,5 (SD = 8,3) év, az EQ VAS 62,0 (SD = 17,2) volt, 690 (53%) betegnek volt már törése. A major osteoporosisos törési és a csípőtörési FRAX ® átlagosan 20,1 (SD = 13,9), illetve 10,6 (SD = 12,5) volt (10 éves korcsoportonkénti átlagok: 18,5/9,3; 16,2/6,7; 23,0/13,5; 28,9/18,3). A törésen átesettek értékei szignifikánsan magasabbak voltak (p<0,05). Következtetések: Megközelítően azonos a primer és szekunder törésprevenci-ós kezelésre járó betegek aránya. Az osteoporosis miatt gondozásban részesülők major osteoporoticus törési FRAX Ten-year fracture risk by FRAX ® of women with osteoporosis attending osteoporosis care in HungaryIntroduction: Identification of patients with high fracture risk is a key-point in osteoporosis care. Aim: To assess the fracture risk among osteoporotic women attending osteoporosis care in Hungary. Method: A cross-sectional survey was conducted in 2009 in 11 centres among women with osteoporosis aged ≥50 years. Main risk factors were recorded and 10-year fracture risk was calculated using the FRAX ® for Hungary. Health status was assessed by EQ VAS. Results: 1301 patients with mean age of 68.5 (SD = 8.3) years and EQ VAS of 62.0 (SD = 17.2) participated, of whom 690 (53.0%) have already had previous fracture. Major osteoporotic and hip fracture FRAX ® scores were 20.1 (SD = 13.9) and 10.6 (SD = 12.5), respectively (by 10-year age groups, mean: 18.5/9.3; 16.2/6.7; 23/13.5; 28.9/18.3). Patients with previous fracture had significantly higher scores (p<0.05). Conclusions: Similar rate of patients attend osteoporosis care for primary and secondary prevention. FRAX ® score was higher than 7% in the majority of patients. The findings provide inputs for cost-effectiveness analyses and development of intervention thresholds in Hungary.

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“…Several studies have utilised administrative databases to compare the real-world effectiveness of different OBPs; Cox proportional hazard models adjusting for risk factors for fracture, including through the use of propensity score methods, have been used to estimate effect differences between OBPs [ 10 – 13 ] and to compare compliant vs. non-compliant patients [ 14 ]. However, these methods adjust only for known confounders.…”

Section: Introductionmentioning

confidence: 99%

Exploring methods for comparing the real-world effectiveness of treatments for osteoporosis: adjusted direct comparisons versus using patients as their own control

et al. 2017

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SummaryUsing Swedish and Dutch registry data for women initiating bisphosphonates, we evaluated two methods of comparing the real-world effectiveness of osteoporosis treatments that attempt to adjust for differences in patient baseline characteristics. Each method has advantages and disadvantages; both are potential complements to clinical trial analyses.PurposeWe evaluated methods of comparing the real-world effectiveness of osteoporosis treatments that attempt to adjust for both observed and unobserved confounding.MethodsSwedish and Dutch registry data for women initiating zoledronate or oral bisphosphonates (OBPs; alendronate/risedronate) were used; the primary outcome was fracture. In adjusted direct comparisons (ADCs), regression and matching techniques were used to account for baseline differences in known risk factors for fracture (e.g., age, previous fracture, comorbidities). In an own-control analysis (OCA), for each treatment, fracture incidence in the first 90 days following treatment initiation (the baseline risk period) was compared with fracture incidence in the 1-year period starting 91 days after treatment initiation (the treatment exposure period).ResultsIn total, 1196 and 149 women initiating zoledronate and 14,764 and 25,058 initiating OBPs were eligible in the Swedish and Dutch registries, respectively. Owing to the small Dutch zoledronate sample, only the Swedish data were used to compare fracture incidences between treatment groups. ADCs showed a numerically higher fracture incidence in the zoledronate than in the OBPs group (hazard ratio 1.09–1.21; not statistically significant, p > 0.05). For both treatment groups, OCA showed a higher fracture incidence in the baseline risk period than in the treatment exposure period, indicating a treatment effect. OCA showed a similar or greater effect in the zoledronate group compared with the OBPs group.ConclusionsADC and OCA each possesses advantages and disadvantages. Combining both methods may provide an estimate of real-world treatment efficacy that could potentially complement clinical trial findings.Electronic supplementary materialThe online version of this article (10.1007/s11657-017-0375-7) contains supplementary material, which is available to authorized users.

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Comparative statistical analysis of osteoporosis treatment based on Hungarian claims data and interpretation of the results in respect to cost-effectiveness

Abstract: Our findings infer that the standardized and uniform health care of osteoporotic patients in a country may reduce general fracture incidence and hospitalization in a cost-effective way.

Cited by 8 publications

References 30 publications

Factors related with osteoporosis treatment in postmenopausal women

Factors related with osteoporosis treatment in postmenopausal women

A szakellátásban megjelenő osteoporosisos nők 10 éves csonttöréskockázata a FRAX^® alapján

Exploring methods for comparing the real-world effectiveness of treatments for osteoporosis: adjusted direct comparisons versus using patients as their own control

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Comparative statistical analysis of osteoporosis treatment based on Hungarian claims data and interpretation of the results in respect to cost-effectiveness

Abstract: Our findings infer that the standardized and uniform health care of osteoporotic patients in a country may reduce general fracture incidence and hospitalization in a cost-effective way.

Cited by 8 publications

References 30 publications

Factors related with osteoporosis treatment in postmenopausal women

Factors related with osteoporosis treatment in postmenopausal women

A szakellátásban megjelenő osteoporosisos nők 10 éves csonttöréskockázata a FRAX® alapján

Exploring methods for comparing the real-world effectiveness of treatments for osteoporosis: adjusted direct comparisons versus using patients as their own control

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A szakellátásban megjelenő osteoporosisos nők 10 éves csonttöréskockázata a FRAX^® alapján