Analysis of osteoporosis treatment patterns with bisphosphonates and outcomes among postmenopausal veterans
| Autor: | Yan Cheng, Candace Haroldsen, Kristin Knippenberg, Thomas Ginter, Olga V. Patterson, Richard E. Nelson, Joanne LaFleur, Tina Willson, Jeffrey R. Curtis, I. Agodoa, Scott L. DuVall, Robert A. Adler |
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| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
Histology Physiology Hospitals Veterans Endocrinology Diabetes and Metabolism medicine.medical_treatment Osteoporosis Population Gee Body Mass Index Medication Adherence Cohort Studies Internal medicine medicine Humans skin and connective tissue diseases education Veterans Affairs Osteoporosis Postmenopausal Aged Natural Language Processing Proportional Hazards Models Veterans Aged 80 and over education.field_of_study Bone Density Conservation Agents Diphosphonates business.industry Bisphosphonate Middle Aged medicine.disease United States Discontinuation Patient Outcome Assessment Cohort Physical therapy Current Procedural Terminology Female sense organs business Osteoporotic Fractures |
| Zdroj: | Bone. 78 |
| ISSN: | 1873-2763 |
| Popis: | Purpose Adherence and persistence with bisphosphonates are frequently poor, and stopping, restarting, or switching bisphosphonates is common. We evaluated bisphosphonate change behaviors (switching, discontinuing, or reinitiating) over time, as well as fractures and costs, among a large, national cohort of postmenopausal veterans. Methods Female veterans aged 50 + treated with bisphosphonates during 2003–2011 were identified in Veterans Health Administration (VHA) datasets. Bisphosphonate change behaviors were characterized using pharmacy refill records. Patients' baseline disease severity was characterized based on age, T-score, and prior fracture. Cox Proportional Hazard analysis was used to evaluate characteristics associated with discontinuation and the relationship between change behaviors and fracture outcomes. Generalized estimating equations were used to evaluate the relationship between change behaviors and cost outcomes. Results A total of 35,650 patients met eligibility criteria. Over 6800 patients (19.1%) were non-switchers. The remaining patients were in the change cohort; at least half displayed more than one change behavior over time. A strong, significant predictor of discontinuation was ≥ 5 healthcare visits in the prior year (11–23% more likely to discontinue), and discontinuation risk decreased with increasing age. No change behaviors were associated with increased fracture risk. Total costs were significantly higher in patients with change behaviors (4.7–19.7% higher). Change-behavior patients mostly had significantly lower osteoporosis-related costs than non-switchers (22%–118% lower). Conclusions Most bisphosphonate patients discontinue treatment at some point, which did not significantly increase the risk of fracture in this majority non-high risk population. Bisphosphonate change behaviors were associated with significantly lower osteoporosis costs, but significantly higher total costs. |
| Databáze: | OpenAIRE |
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