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A Retrospective Longitudinal Database Study of Persistence and Compliance with Treatment of Osteoporosis in Hungary

Abstract

This study assessed persistence and compliance with anti-osteoporosis therapies, and associations between compliance and clinical outcomes (fracture, fracture-related hospitalization and death), in Hungarian women with postmenopausal osteoporosis. The study used the Hungarian National Health Insurance Fund Administration database and included women with PMO aged at least 50 years, for whom a prescription for anti-osteoporosis medication had been filled between 1 January 2004 and 31 December 2013 (index event). Persistence (prescription refilled within 8 weeks of the end of the previous supply) was evaluated over 2 years; good compliance (medication possession ratio ≥ 80 %) was evaluated at 1 year. Associations between compliance and clinical outcomes (data collected for up to 6 years) were assessed with adjustment for baseline covariates. A total of 296,300 women met the inclusion criteria (524,798 index events). Persistence and compliance were higher for less frequent and parenteral therapies (1- and 2-year persistence: half-yearly [parenteral] vs. daily/weekly/monthly [oral and parenteral], 81 and 38 % vs. 21–34 and 10–18 %, respectively; parenteral vs. oral, 75 and 36 % vs. 32 and 16 %; good compliance: half-yearly vs. daily/weekly/monthly, 70 vs. 24–39 %; parenteral vs. oral 78 vs. 36 %). Good compliance significantly reduced the risks of fracture, fracture-related hospitalization and death (relative risk vs. non-compliance [95 % confidence interval]: 0.77 [0.70–0.84], 0.72 [0.62–0.85] and 0.57 [0.51–0.64], respectively; P < 0.01). Improving compliance through long-interval parenteral therapies may result in clinical benefits for patients.

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Acknowledgments

Statistical support was provided by Pál Rakonczai and Tamás Balázs of HealthWare Consulting Ltd (funded by Amgen [Europe] GmbH). Editing support was provided by Claire Desborough, of Amgen (Europe) GmbH, and Oxford PharmaGenesis (funded by Amgen [Europe] GmbH).

Author Contributors

PL designed the study, interpreted the data and prepared early drafts of the paper. PL is guarantor. IT and IM interpreted the data. ET designed the study, and acquired, analysed and interpreted the data. CZ and ZL acquired, analysed and interpreted the data. EP and MI designed the study and interpreted the data. All authors revised the paper critically for intellectual content and approved the final version. All authors agree to be accountable for the work and to ensure that any questions relating to the accuracy and integrity of the paper are investigated and properly revised.

Funding

The study was funded by Amgen (Europe) GmbH.

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Correspondence to Péter Lakatos.

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Conflict of Interest

PL, IT and IM have received consulting, research and speaker fees and grants from many companies with drugs for bone diseases, including Amgen. ET was an employee of Healthware Tanácsadó Kft when the study was conducted and has been in employment at UCB Biopharma Sprl as a Senior Manager Health Economics & Outcomes Research from December 2013. ZL and CZ are/were employees of Healthware Ltd and conducted this research under contract to Amgen. MI and EP are employees and shareholders of Amgen.

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Lakatos, P., Takács, I., Marton, I. et al. A Retrospective Longitudinal Database Study of Persistence and Compliance with Treatment of Osteoporosis in Hungary. Calcif Tissue Int 98, 215–225 (2016). https://doi.org/10.1007/s00223-015-0082-6

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  • DOI: https://doi.org/10.1007/s00223-015-0082-6

Keywords

  • Compliance
  • Death
  • Fracture
  • Hospitalization
  • Osteoporosis
  • Persistence