title: Cost-effectiveness of enhancing adherence with oral bisphosphonates treatment in osteoporotic women: an empirical approach based on healthcare utilisation databases.
abstract: OBJECTIVE
  Adherence with bisphosphonates therapy is generally low. Enhancing adherence with bisphosphonates would be effective in achieving the full benefits of therapy albeit a growth in the expenditure for supporting incremented drug use is expected. The cost-effectiveness of enhancing adherence with oral bisphosphonates in a large population of osteoporotic women has been assessed in the current study.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Healthcare utilisation databases of Lombardy Region, Italy.
  
  
  METHODS
  A cohort of 28 558 women aged 45 years or more, resident in the Italian Region of Lombardy, who were newly treated with oral bisphosphonates during 2003-2004, was followed for 6 years after index prescription.
  
  
  METHODS
  Fracture-free survival time, healthcare cost and incremental cost-effectiveness ratio (ICER) of enhancing adherence, that is, the additional cost that would be spent every year for gaining one fracture-free year as a consequence of enhancing adherence at a certain level.
  
  
  RESULTS
  Enhanced adherence from 33% (baseline) to 80%, increased both fracture-free survivals from 970 to 973 years and healthcare costs from €118 000 to €265 000 every 1000 woman-years, with ICER value of €53 000 (95% CI €49 000 to €58 000). ICER values were lower for older women (€50 000; 95% CI €42 000 to €58 000) and for those suffering from at least a chronic comorbidity (€25000; 95% CI 95% CI €7000 to €47 000).
  
  
  CONCLUSIONS
  Enhancing adherence with oral bisphosphonates offers important benefits in reducing the risk of fracture, although at a substantial cost.
authors.affiliation: Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Scotti
authors.forename: Andrea
authors.initials: A
authors.lastname: Arfè
authors.forename: Antonella
authors.initials: A
authors.lastname: Zambon
authors.forename: Luca
authors.initials: L
authors.lastname: Merlino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000191:economics* / Q000627:therapeutic use; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D004164:Diphosphonates / Q000191:economics* / Q000627:therapeutic use; D016527:Drug Costs; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D017048:Health Care Costs; D006801:Humans; D007558:Italy; D055118:Medication Adherence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Epidemiology; Health Economics; Public Health