, Volume 24, Issue 4, pp 1195-1206
Date: 26 Oct 2012

Association between osteoporosis treatment change and adherence, incident fracture, and total healthcare costs in a Medicare Advantage Prescription Drug plan

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Abstract

Summary

We examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among Medicare Advantage Prescription Drug (MAPD) plan members. Treatment change was associated with a small but significant increase in adherence, but was not associated with incident fracture or total healthcare costs. Overall adherence remained low.

Introduction

We examined the association between osteoporosis treatment change and adherence, incident fractures, and healthcare costs among MAPD plan members in a large US health plan.

Methods

We conducted a retrospective cohort study of MAPD plan members aged ≥50 years newly initiated on an osteoporosis medication between 1 January 2006 and 31 December 2008. Members were identified as having or not having an osteoporosis treatment change within 12 months after initiating osteoporosis medication. Logistic regression analyses and difference-in-difference (DID) generalized linear models were used to investigate the association between osteoporosis treatment change and (1) adherence to treatment, (2) incident fracture, and (3) healthcare costs at 12 and 24 months follow-up.

Results

Of the 33,823 members newly initiated on osteoporosis treatment, 3,573 (10.6 %) changed osteoporosis treatment within 12 months. After controlling for covariates, osteoporosis treatment change was associated with significantly higher odds of being adherent (medication possession ratio [MPR] ≥ 0.8) at 12 months (odds ratio [OR] = 1.18) and 24 months (OR = 1.13) follow-up. However, overall adherence remained low (MPR = 0.59 and 0.51 for the change cohort and MPR = 0.51 and 0.44 for the no-change cohort at 12 and 24 months, respectively). Osteoporosis treatment change was not significantly associated with incident fracture (OR = 1.00 at 12 months and OR = 0.98 at 24 months) or total direct healthcare costs (p > 0.4) in the DID analysis, but was associated with higher pharmacy costs (p < 0.004).

Conclusions

Osteoporosis treatment change was associated with a small but significant increase in adherence, but was not associated with incident fracture or total healthcare costs in the MAPD plan population. Overall adherence to therapy remained low.

This work was presented in part as an abstract at the American Society for Bone and Mineral Research (ASBMR, 16–20 September 2011; San Diego, CA, USA) and at the Academy of Managed Care Pharmacy, 2011 Education Conference (AMCP, 19–21 October 2011; Atlanta, GA, USA).