Abstract
Summary
Adherence to, and persistence with, treatments for osteoporosis are low. Adherence with teriparatide decreases over time. Higher copayments in the commercial/Medicare population were associated with worse persistence. Understanding factors such as prior screening, prior treatment history, and out of pocket costs that influence persistence with teriparatide may help clinicians make informed decisions.
Introduction
The purpose of this study was to evaluate adherence and persistence with teriparatide.
Methods
Beneficiaries with at least one claim for teriparatide in 2003 or 2004 and continuous enrollment in the previous 12 months and subsequent 6 months were identified in a national commercial/Medicare and Medicaid administrative claims database (MarketScan®). Adherence was assessed through calculation of the medication possession ratio (MPR). Persistence was measured by time until discontinuation and time until first 60-day gap in treatment. Factors associated with persistence were assessed using Cox proportional hazards models.
Results
The average MPR at 6 months was 0.74 (N = 2,218) and at 12 months, was 0.66 (N = 1,303). At 6 months, 64.6% of patients remained on therapy and at 12 months, 56.7% remained. Bone mineral density screening and use of antiresorptive therapy within the 12 months pre-period, and lower patient copayments were associated with increased persistence.
Conclusion
Patients appear to have good adherence with teriparatide over the first 6 months which declines over time. Prior screening and treatment of osteoporosis and out of pocket costs appear to impact persistence. To optimize patient outcomes, clinicians should consider clinical factors that impact persistence, while healthcare decision makers should consider the negative effect of higher patient copayments on persistence.
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Acknowledgments
We gratefully acknowledge the assistance of Marcus Healey in the preparation and editing of this manuscript. Funding for this work was supported by Eli Lilly and Company.
Conflicts of interest
Shonda Foster, Eric Meadows, Joseph Johnston and Gerhardt Pohl are employees and stockholders of Eli Lilly and Company. Stacey Long and Sara Wang are employees of Thomson Reuters, and Kathleen Foley was an employee of Thomson Reuters during the time this study was conducted. Eli Lilly and Company funded this study and contracted with Thomson Reuters to conduct the analysis.
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Foster, S.A., Foley, K.A., Meadows, E.S. et al. Adherence and persistence with teriparatide among patients with commercial, Medicare, and Medicaid insurance. Osteoporos Int 22, 551–557 (2011). https://doi.org/10.1007/s00198-010-1297-z
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DOI: https://doi.org/10.1007/s00198-010-1297-z