The impact of persistence with bisphosphonates on health resource utilization and fracture risk in the UK: a study of patient records from the UK Clinical Practice Research Datalink.
OBJECTIVE
Clinical trial data suggest that patients who have received bisphosphonates continue to benefit from them after discontinuation. However, data from real-world clinical practice are inconclusive. We assessed the impact of persistence and discontinuation on health resource utilization (HRU) and fracture rate in women who were prescribed oral bisphosphonates.


METHODS
The study used data from the UK Clinical Practice Research Datalink. Women aged 50 years or older with a first prescription of oral bisphosphonate therapy between January 2000 and December 2007 were included. Multivariate modelling compared rate ratios for fracture and HRU between patients who had discontinued medication (shorter persistence group) and patients who took their medication for longer (longer persistence group). The interactions of elapsed time (measured as 6-month intervals) with HRU and with fracture rate for all patients within paired groups were also assessed.


RESULTS
Overall, 36 320 patients were included. Pairwise comparisons showed that HRU and fracture rates were lower in longer persistence groups than in shorter persistence groups. Analysis by 6-month interval showed that, across all patients in persistence group pairs, HRU significantly increased for each additional 6 months elapsed; trends towards increased risk of fracture were also seen.


CONCLUSIONS
In contrast to results from clinical trials, in this patient population the protective effect of oral bisphosphonates after discontinuation was not sufficient to reduce HRU and fracture rates to the levels that would be seen if patients had continued on therapy. Reducing the rate of treatment discontinuation may decrease the burden that osteoporosis places on both patients and health care systems.
United Kingdom Value, Access & Policy, Amgen Ltd, Cambridge, UK.
Samara
S
Ferguson
Center for Observational Research, Amgen Ltd, Uxbridge, UK.
Maurille
M
Feudjo Tepie
Clinical Development, Amgen Ltd, Cambridge, UK.
Andrew
A
Taylor
Clinical Development, Amgen Ltd, Uxbridge, UK.
Andrew
A
Roddam
Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA.
Cathy
C
Critchlow
Scientific Affairs, Amgen Ltd, Cambridge, UK.
Mazhar
M
Iqbal
Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA.
Leslie
L
Spangler
Faculty of Education, Health and Sciences, University of Derby, Derby, UK.
Jonathan
J
Bayly
D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000517:prevention & control; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D006113:United Kingdom / Q000453:epidemiology; D016903:Drug Monitoring
D050071:Bone Density Conservation Agents; D004164:Diphosphonates
Clinical Practice Research Datalink; bisphosphonate; fracture; health resource utilization; medication adherence; osteoporosis