J LaFleur1, S L DuVall2, T Willson2, T Ginter3, O Patterson3, Y Cheng2, K Knippenberg4, C Haroldsen5, R A Adler6, J R Curtis7, I Agodoa8, R E Nelson5. 1. Pharmacotherapy Outcomes Research Center, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112, USA; VA Salt Lake City Heath Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA. Electronic address: joanne.lafleur@pharm.utah.edu. 2. Pharmacotherapy Outcomes Research Center, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112, USA; VA Salt Lake City Heath Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA. 3. VA Salt Lake City Heath Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA. 4. Pharmacotherapy Outcomes Research Center, University of Utah, 30 South 2000 East, Salt Lake City, UT 84112, USA. 5. VA Salt Lake City Heath Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA; Department of Internal Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA. 6. Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23224, USA. 7. Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 1825 University Boulevard, Birmingham, AL 35294-2182, USA. 8. Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, CA 91320, USA.
Abstract
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.
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 bisphosphonatepatients 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.
Authors: Joanne LaFleur; Eileen Rillamas-Sun; Cathleen S Colón-Emeric; Kristin A Knippenberg; Kristine E Ensrud; Shelly L Gray; Jane A Cauley; Andrea Z LaCroix Journal: Gerontologist Date: 2016-02
Authors: Joanne LaFleur; Adam P Bress; Joel Myers; Lisa Rosenblatt; Jacob Crook; Kristin Knippenberg; Roger Bedimo; Pablo Tebas; Heather Nyman; Stephen Esker Journal: Infect Dis Ther Date: 2018-02-28
Authors: Elisheva R Danan; Erin E Krebs; Kristine Ensrud; Eva Koeller; Roderick MacDonald; Tina Velasquez; Nancy Greer; Timothy J Wilt Journal: J Gen Intern Med Date: 2017-09-14 Impact factor: 5.128