title: Adherence and persistence with teriparatide among patients with commercial, Medicare, and Medicaid insurance.
abstract: Adherence to, and persistence with, treatments for osteoporosis are low. Adherence with teriparatide decreases over time. Higher copayments in the commercial/Medicare population were associated with worse persistence. Understanding factors such as prior screening, prior treatment history, and out of pocket costs that influence persistence with teriparatide may help clinicians make informed decisions.
  
  
  BACKGROUND
  The purpose of this study was to evaluate adherence and persistence with teriparatide.
  
  
  METHODS
  Beneficiaries with at least one claim for teriparatide in 2003 or 2004 and continuous enrollment in the previous 12 months and subsequent 6 months were identified in a national commercial/Medicare and Medicaid administrative claims database (MarketScan®). Adherence was assessed through calculation of the medication possession ratio (MPR). Persistence was measured by time until discontinuation and time until first 60-day gap in treatment. Factors associated with persistence were assessed using Cox proportional hazards models.
  
  
  RESULTS
  The average MPR at 6 months was 0.74 (N=2,218) and at 12 months, was 0.66 (N=1,303). At 6 months, 64.6% of patients remained on therapy and at 12 months, 56.7% remained. Bone mineral density screening and use of antiresorptive therapy within the 12 months pre-period, and lower patient copayments were associated with increased persistence.
  
  
  CONCLUSIONS
  Patients appear to have good adherence with teriparatide over the first 6 months which declines over time. Prior screening and treatment of osteoporosis and out of pocket costs appear to impact persistence. To optimize patient outcomes, clinicians should consider clinical factors that impact persistence, while healthcare decision makers should consider the negative effect of higher patient copayments on persistence.
authors.affiliation: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA. fostersa@lilly.com
authors.forename: S A
authors.initials: SA
authors.lastname: Foster
authors.forename: K A
authors.initials: KA
authors.lastname: Foley
authors.forename: E S
authors.initials: ES
authors.lastname: Meadows
authors.forename: J A
authors.initials: JA
authors.lastname: Johnston
authors.forename: S S
authors.initials: SS
authors.lastname: Wang
authors.forename: G M
authors.initials: GM
authors.lastname: Pohl
authors.forename: S R
authors.initials: SR
authors.lastname: Long
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000191:economics; D017047:Cost Sharing; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000191:economics; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D019379:Teriparatide / Q000008:administration & dosage* / Q000191:economics; D014481:United States
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide
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