HEC-School of Management, Department of Economics, University of Liège, Boulevard du Rectorat 7, Liège 1, Belgium.
Health Policy. 2010 Jul;96(2):170-7. doi: 10.1016/j.healthpol.2010.01.014. Epub 2010 Feb 13.
This study aims to estimate the clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients and the potential cost-effectiveness of adherence-enhancing interventions.
A validated Markov microsimulation model estimated costs and outcomes (i.e. the number of fractures and the quality-adjusted life-year (QALY)) for three adherence scenarios: no treatment, real-world adherence and full adherence over 3 years. The real-world adherence scenario employed data from a published observational study. The incremental cost per QALY gained was estimated and compared across the three adherence scenarios.
The number of fractures prevented and the QALY gain obtained at real-world adherence levels represented only 38.2% and 40.7% of those expected with full adherence, respectively. The cost per QALY gained of real-world adherence compared with no treatment was estimated at euro 10279, and full adherence was found to be cost-saving compared with real-world adherence.
This study suggests that more than half of the potential clinical benefits from oral bisphosphonates in patients with osteoporosis are lost due to poor adherence with treatment. Depending on their cost, interventions with improved adherence to therapy have the potential to be an attractive use of resources.
本研究旨在评估骨质疏松症患者不依从口服双膦酸盐治疗的临床和经济负担，以及增强依从性干预措施的潜在成本效益。
经验证的 Markov 微模拟模型估算了三种依从性情景下的成本和结局（即骨折数量和质量调整生命年（QALY））：不治疗、真实世界依从性和 3 年内完全依从性。真实世界依从性情景采用了已发表的观察性研究数据。对三种依从性情景的增量成本效益比进行了估计和比较。
在真实世界依从性水平下预防的骨折数量和获得的 QALY 增益分别仅为完全依从性预期值的 38.2%和 40.7%。与不治疗相比，真实世界依从性的每 QALY 成本为 10279 欧元，而与真实世界依从性相比，完全依从性具有成本效益。
本研究表明，由于治疗依从性差，骨质疏松症患者接受口服双膦酸盐治疗的潜在临床获益有一半以上丧失。取决于其成本，改善治疗依从性的干预措施具有吸引资源的潜力。
