Association between osteoporosis treatment change and adherence, incident fracture, and total healthcare costs in a Medicare Advantage Prescription Drug plan
Association between osteoporosis treatment change and adherence, incident fracture, and total healthcare costs in a Medicare Advantage Prescription Drug plan
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DOI：
10.1007/s00198-012-2140-5
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发表时间：
2013-04
影响因子：
4
通讯作者：
M. Ward;Y. Xu;H. Viswanathan;Bradley S. Stolshek;B. Clay;J. L. Adams;J. Kallich;S. Fine;K. Saag
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文献类型：
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作者：
M. Ward;Y. Xu;H. Viswanathan;Bradley S. Stolshek;B. Clay;J. L. Adams;J. Kallich;S. Fine;K. Saag
我们研究了骨质疏松症治疗变化和依从性之间的关系，骨折事件，医疗保险优势处方药（MAPD）计划成员的医疗费用。治疗改变与依从性的小幅但显著增加相关，但与骨折事件或总医疗费用无关。整体adherence仍然low.IntroductionWe检查了骨质疏松症治疗的变化和坚持，骨折事件，和医疗费用之间的关联MAPD计划成员在一个大型的美国health plannes.MethodsWe进行了回顾性队列研究年龄≥50岁的MAPD计划成员新启动的骨质疏松症药物治疗2006年1月1日和2008年12月31日之间。在开始骨质疏松症药物治疗后的12个月内，成员被确定为有或没有骨质疏松症治疗变化。Logistic回归分析和差分（DID）广义线性模型用于研究骨质疏松症治疗变化与（1）治疗依从性，（2）骨折事件和（3）12个月和24个月随访时的医疗费用之间的关系。573例（10.6%）在12个月内改变了骨质疏松治疗。在控制协变量后，骨质疏松症治疗变化与12个月（比值比[OR] = 1.18）和24个月（OR = 1.13）随访时依从性（药物拥有比[MPR] ≥ 0.8）的比值显著较高相关。然而，总体依从性仍然较低（在12个月和24个月时，变更队列的MPR分别为0.59和0.51，无变更队列的MPR分别为0.51和0.44）。骨质疏松症治疗变化与骨折发生率无显著相关性（12个月时OR = 1.00，24个月时OR = 0.98）或直接医疗保健总费用（p> 0.4），但与较高的药房费用相关（p< 0.004）.结论骨质疏松症治疗的改变与依从性的小幅但显著的增加有关，但与MAPD计划人群中的骨折事件或总医疗费用无关。对治疗的总体依从性仍然很低。
SummaryWe examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among Medicare Advantage Prescription Drug (MAPD) plan members. Treatment change was associated with a small but significant increase in adherence, but was not associated with incident fracture or total healthcare costs. Overall adherence remained low.IntroductionWe examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among MAPD plan members in a large US health plan.MethodsWe conducted a retrospective cohort study of MAPD plan members aged ≥50 years newly initiated on an osteoporosis medication between 1 January 2006 and 31 December 2008. Members were identified as having or not having an osteoporosis treatment change within 12 months after initiating osteoporosis medication. Logistic regression analyses and difference-in-difference (DID) generalized linear models were used to investigate the association between osteoporosis treatment change and (1) adherence to treatment, (2) incident fracture, and (3) healthcare costs at 12 and 24 months follow-up.ResultsOf the 33,823 members newly initiated on osteoporosis treatment, 3,573 (10.6 %) changed osteoporosis treatment within 12 months. After controlling for covariates, osteoporosis treatment change was associated with significantly higher odds of being adherent (medication possession ratio [MPR] ≥ 0.8) at 12 months (odds ratio [OR] = 1.18) and 24 months (OR = 1.13) follow-up. However, overall adherence remained low (MPR = 0.59 and 0.51 for the change cohort and MPR = 0.51 and 0.44 for the no-change cohort at 12 and 24 months, respectively). Osteoporosis treatment change was not significantly associated with incident fracture (OR = 1.00 at 12 months and OR = 0.98 at 24 months) or total direct healthcare costs (p> 0.4) in the DID analysis, but was associated with higher pharmacy costs (p< 0.004).ConclusionsOsteoporosis treatment change was associated with a small but significant increase in adherence, but was not associated with incident fracture or total healthcare costs in the MAPD plan population. Overall adherence to therapy remained low.