PMS54 The Clinical and Economic Burden of Poor Adherence with Osteoporosis Medications in Ireland

Abstract

performed. RESULTS: Incremental cost effectiveness ratios were calculated for each anti-TNF in comparison to methotrexate. Infliximab is dominated in almost all scenarios, being more costly and less effective. Etanercept and adalimumab are the most effective options and most costly. Golimumab appears less effective and less costly. Sensitivity analysis around utility measure and HAQ improvement assumptions indicate that these are key drivers to the estimates. CONCLUSIONS: This CUA focuses on novel methods for data inputs estimation. Both Bayesian and frequentist methods are employed in order to validate the sub models used. The outputs from the cost utility model show that etanercept and adalimumab appear most effective on the cost effectiveness plane. However they are also more costly than both golimumab and certolizumab pegol.OBJECTIVES: Falls/Slips cases injured with over the level two and their medical costs for a year of 2008 at 3 teaching hospitals are explored. METHODS: There are 2559, 1394, and 4086 incident reports in 2008 collected at . Their reports include 565, 399, and 561 cases for Falls/Slips. The cases are classified 264, 176, and 306 cases with level 2, and 89, 32, and 82 cases with level 3a, and 8, 3, and 5 cases with level 3b, respectively. We explored 963 cases with over level 2 in order to calculate additional medical costs by using their own administrative profiling data. RESULTS: According to the injury level, average AMCs are 108 at SMH, 175 at SUH and, 72 USD at KUH (level 2), respectively. Similarly, Average AMCs are 122, 223, and 97 USD (level 3a), and 1,431, 7,745 and 33,357 USD (level 3b), respectively.With regard to clinical services, AMC with diagnostic imaging is the highest (10,118 USD, SMH; 14,090 USD, SUH), but AMC with surgery/treatment is the highest at KUH, 92,115 USD. AMC with surgery/treatment is 6900 USD at SMH, and 8879 USD at SUH, AMC with iv/div is 1275 USD at SMH and 1818 USD at SUH, AMC with laboratory examination is 674 USD at SMH, and 899 USD at SUH, and AMC with drug administration is 455 USD at SMH and 318 USD at SUH. By contrast, AMCs at KUH are 11578 USD (imaging), 11290 USD (examination), 3372 USD (drug administration), and 714 USD (iv/div), because AMC with level 3b and over is the highest by clinical services. CONCLUSIONS: Therefore, Hospital administrators and policy makers have to take appropriate measures to prevent patients from Falls/Slips and save money, because this amount is not overlooked.

Cost Effectiveness of Denosumab Compared with Oral Bisphosphonates in the Treatment of Post-Menopausal Osteoporotic Women in Belgium

“…The model used in this study has been previously validated [20] and has been used in a number of studies to model the cost effectiveness of osteoporosis management. [10,27,55,58,61,75,76] The methodology used to incorporate compliance and persistence with oral bisphosphonates has also been recently published. [10,61] Nevertheless, like all models, several limitations must be taken into account.…”

“…adherence data and model assumptions) have been previously extensively discussed. [10,20] In particular, assumptions and data on adherence to oral bisphosphonates, which play a key role in the cost effectiveness of denosumab, should be acknowledged. First, a refill gap period of 5 weeks was used to define non-persistence in the Belgian observational study.…”

“…However, an MPR of 80% was commonly used to define high compliance [8] and the use of other thresholds had limited impact on cost effectiveness in another study. [10] In any event, the cost effectiveness of denosumab was shown to be moderately sensitive to compliance with oral bisphosphonates.…”

“…The methodology used to incorporate compliance and persistence with oral bisphosphonates has been published recently. [10,61] Based on the Belgian observational study, [49] 42.5% of women discontinued oral bisphosphonates within 6 months. For these women, no treatment effect was received [62] and we assigned 3 months of therapy cost, as previously suggested.…”

“…[6][7][8] Approximately 75% of women who initiate oral bisphosphonates were shown to be non-adherent within 1 year and 50% discontinued therapy by this time, [9] resulting in significant clinical and economic burden. [10] Determinants of poor adherence include inconvenient regimens, adverse effects and lack of motivation. [11,12] Denosumab represents a new therapeutic opportunity for the treatment of osteoporosis.…”