Methodological considerations in using claims databases to evaluate persistence with bisphosphonates for osteoporosis.
OBJECTIVE
To demonstrate that retrospective analyses of medication persistence require careful methodological approaches to assure accuracy and consistency across various types of databases. Bisphosphonates (BPs) are used as an example because of the availability of diverse dosing options that can create a unique set of challenges for persistence analyses.


METHODS
Reports of BP persistence were compared for methodological approaches, including data source, duration of follow-up, allowed gap for persistence, and presentation of results.


METHODS
Medication persistence.


RESULTS
Comparisons among reports of BP persistence for weekly and monthly formulations revealed inconsistent definitions and a variety of methods. Persistence analyses varied greatly, particularly in allowed gaps and adjustment for demographic and clinical characteristics that affected results. Persistence with weekly dosing was 179-249 days, with 24-78% remaining on treatment at 1 year. Analyses of persistence with monthly treatment was complicated by the variety of gap lengths (30-90 days). The studies reviewed had many limitations, including lack of an established threshold for efficacy, inadequacy of information in databases, and potential biases in case selection (treatment-naive or experienced).


CONCLUSIONS
The limitations of published studies reveal the need for a more consistent approach to medication persistence analyses using claims databases to allow for comparison across reports. The analysis plan should present definitions of all terms, details of all methods and types of adjustments needed for demographic and clinical characteristics, as well as specify allowed gaps between refills. These approaches would improve clinical utility of data describing BP persistence and its impact on fracture risk.
Cramer
Joyce A
JA
Department of Psychiatry, Yale UniversitySchool of Medicine, 950 Campbell Avenue (151D), West Haven, CT 06516-2770, USA. joyce.cramer@yale.edu
Silverman
Stuart L
SL
Gold
Deborah T
DT
D004164:Diphosphonates / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D007345:Insurance Claim Review; D010024:Osteoporosis / Q000188:drug therapy*; D010349:Patient Compliance
D004164:Diphosphonates