Cost-effectiveness Strategies to Treat Osteoporosis in Elderly Women

Pfister, Alfred K.; Welch, Christine A.; Lester, Melissa; Emmett, Mary; Saville, Paul D.; Duerring, Shea A.

doi:10.1097/01.smj.0000202090.30647.61

Cited by 23 publications

(11 citation statements)

References 47 publications

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“…Women with osteoporosis can reduce the risk of bone fractures by taking prescription osteoporosis drugs, which can be a cost-effective means of reducing fractures (Qaseem et al, 2008; Tosteson, Burge, Marshall, & Lindsay, 2008; Pfister et al, 2006; Zethraeus, Borgström, Ström, Kanis, & Jönsson, 2007; Hagen et al, 2011; King, Saag, Burge, Pisu, & Goel, 2005; Borgström & Kanis, 2008). According to treatment guidelines and the recommendation from National Osteoporosis Foundation, newly diagnosed osteoporosis patients should receive pharmaceutical osteoporosis treatments.…”

Section: Introductionmentioning

confidence: 99%

Access to Oral Osteoporosis Drugs Among Female Medicare Part D Beneficiaries

Lin

Karaca‐Mandic

McCullough

et al. 2014

Women's Health Issues

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Background For women living with osteoporosis, high out-of-pocket drug costs may prevent drug therapy initiation. We investigate the association between oral osteoporosis out-of-pocket medication costs and female Medicare beneficiaries’ initiation of osteoporosis drug therapy. Methods We used 2007 and 2008 administrative claims and enrollment data for a 5% random sample of Medicare beneficiaries. Our study sample included age-qualified, female beneficiaries who had no prior history of osteoporosis but were diagnosed with osteoporosis in 2007 or 2008. Additionally, we only included beneficiaries continuously enrolled in standalone prescription drug plans. We excluded beneficiaries who had a chronic condition that was contraindicated with osteoporosis drug utilization. Our final sample included 25,069 beneficiaries. Logistic regression analysis was used to examine the association between the out-of-pocket costs and initiation of oral osteoporosis drug therapy during the year of diagnosis. Findings Twenty-six percent of female Medicare beneficiaries newly diagnosed with osteoporosis initiated oral osteoporosis drug therapy. Beneficiaries’ out-of-pocket costs were not associated with the initiation of drug therapy for osteoporosis. However, there were statistically significant racial disparities in beneficiaries’ initiation of drug therapy. African Americans were 3 percentage points less likely to initiate drug therapy than whites. In contrast, Asian/Pacific Islander and Hispanic beneficiaries were 8 and 18 percentage points respectively more likely to initiate drug therapy than whites. Additionally, institutionalized beneficiaries were 11 percentage points less likely to initiate drug therapy than other beneficiaries. Conclusions Access barriers for drug therapy initiation may be driven by factors other than patients’ out-of-pocket costs. These results suggest that improved osteoporosis treatment requires a more comprehensive approach that goes beyond payment policies.

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Section: Introductionmentioning

confidence: 99%

Access to Oral Osteoporosis Drugs Among Female Medicare Part D Beneficiaries

Lin

Karaca‐Mandic

McCullough

et al. 2014

Women's Health Issues

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“…This often means that conclusions drawn from these analyses are of limited value. Some studies used a fixed rate of nonadherence [37,38,45,50 -54,], others assumed an increase during the treatment period [8,42,44,48,49], and a third group considered nonadherence only in a sensitivity analysis [40,41,46,57]. In some studies, realistic assumptions (i.e., a decrease in adherence over time) were provided either for persistence or for compliance without justifying the exclusion of other aspects of adherence.…”

Section: Discussionmentioning

confidence: 99%

“…This ranged from 20% to 100%, often without evidence for justification. Among studies that considered nonadherence in the base case, five analyses (all of them based on fixed threshold) assumed a linear decline in adherence [41,42,44,48,49], while seven studies assumed a fixed nonadherence [38,39,45,50 -54,].…”

Section: Methodological Quality Of the Analysesmentioning

confidence: 99%

Cost-Effectiveness of Different Strategies for Selecting and Treating Individuals at Increased Risk of Osteoporosis or Osteopenia: A Systematic Review

2012

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Risk assessment using variable thresholds appears to be more cost-effective than selecting high-risk individuals by fixed thresholds. Although the overall quality of the studies was fairly good, future economic analyses should further improve their methods, particularly in terms of including more fracture types, incorporating medication adherence, and including or discussing unrelated costs during added life-years.

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“…The cost per QALY gained for BMD testing and treatment intervention was less than $15,000 among ambulatory nursing home residents age 85 or older, for whom prevention of hip fractures would not result in lower longterm care costs. Similarly, a modeling study for females age 65 and older in West Virginia found that the cost per QALY gained with universal bone densitometry followed by 5 years of oral bisphosphonate therapy was $32,000 compared to no drug therapy, including the upfront casefinding costs of bone densitometry [18].…”

Section: Using Bone Mineral Density To Select Treatment Cohortmentioning

confidence: 99%

“…Two other studies were equally pessimistic regarding the cost-effectiveness of teriparatide [14,18]. An industrysponsored study, in contrast, reported a much more favorable cost per QALY gained (€64,000) of teriparatide compared to no drug therapy for 69-year-old Swedish women with femoral neck T-scores of -3 and prevalent vertebral fractures [20].…”

Section: Using Bone Mineral Density To Select Treatment Cohortmentioning

confidence: 99%

Cost-effectiveness modeling research of pharmacologic therapy to prevent osteoporosis-related fractures

Schousboe

2007

Curr Rheumatol Rep

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Osteoporotic fractures are common among postmenopausal women and elderly men, and they cause substantial direct medical costs and loss of quality of life. The potential costs of widespread intervention strategies to reduce the incidence of fractures are also quite high. Therefore, the cost-effectiveness of such interventions is highly significant to large-scale health insurers and healthcare systems. Most modeling studies to date have examined the cost-effectiveness of pharmacologic treatment for subsets of postmenopausal women selected on the basis of bone mineral density and/or prevalent vertebral fracture. They generally suggest that oral bisphosphonates and raloxifene are cost-effective therapies for these subsets. Increasingly, modeling studies of treatments for those selected on the basis of absolute fracture risk rather than bone density criteria are being done to establish absolute fracture risk thresholds at which various treatments are cost-effective.

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Cost-effectiveness Strategies to Treat Osteoporosis in Elderly Women

Abstract: Only bisphosphonates are cost-effective for fracture prevention in osteoporotic women aged 65 or older and this economic advantage is also maintained in subsets who have a lower relative risk of future fracture.

Cited by 23 publications

References 47 publications

Access to Oral Osteoporosis Drugs Among Female Medicare Part D Beneficiaries

Access to Oral Osteoporosis Drugs Among Female Medicare Part D Beneficiaries

Cost-Effectiveness of Different Strategies for Selecting and Treating Individuals at Increased Risk of Osteoporosis or Osteopenia: A Systematic Review

Cost-effectiveness modeling research of pharmacologic therapy to prevent osteoporosis-related fractures

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