title: The societal burden of poor persistence to treatment of osteoporosis in Sweden.
abstract: OBJECTIVE
  Poor persistence to prescribed treatment regimens is a well-documented health problem. The issue is of particular importance in treatment of chronic diseases, such as osteoporosis. The objective of this study was to estimate the annual societal burden of real-world persistence to treatment of osteoporosis in Sweden. A second aim was to estimate the monetary net benefit of improved persistence.
  
  
  METHODS
  The annual societal burden was evaluated in relation to perfect persistence to a five-year treatment duration and performed using a published Markov model by Ström and colleagues. The target population was extracted from the Swedish Prescribed Drug Register and based on all treatment-naïve patients who started therapy of primary osteoporosis in Sweden during 2009. Five hypothetical interventions were investigated, with improvements in the persistent proportion of between 10% and 50%.
  
  
  RESULTS
  Annually, a total of 1018 fractures were estimated to be caused by non-persistence to treatment of osteoporosis in Sweden. These fractures resulted in a substantial waste of health care resources related to morbidity (€26 million annually) and a loss, in total, of 771 quality-adjusted life-years (QALYs). Using a societal willingness-to-pay for a QALY of €60000, the total annual societal burden, incorporating both monetary consequences and health effects, was estimated at €62.76 million. Given current Swedish cost-effectiveness guidelines, between approximately €225 and €1130 could be spent per patient to increase persistence, depending on the level of improvement (between 10% and 50%).
  
  
  CONCLUSIONS
  The total annual societal burden of current, real-world persistence was estimated at €63 million. The estimated additional fracture-related costs associated with poor persistence were larger than the current total annual expenditure on all osteoporosis medications in Sweden. Poor persistence to treatment of osteoporosis should consequently be acknowledged as an important and costly health problem, and be taken into account when evaluating osteoporosis interventions.
authors.affiliation: i3 Innovus, Stockholm, Sweden. erik.landfeldt@i3innovus.com
authors.forename: Erik
authors.initials: E
authors.lastname: Landfeldt
authors.forename: Jonas
authors.initials: J
authors.lastname: Lundkvist
authors.forename: Oskar
authors.initials: O
authors.lastname: Ström
mesh_terms: D019386:Alendronate / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy* / Q000191:economics*; D013548:Sweden
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate