WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX, UK.
Osteoporos Int. 2011 Oct;22(10):2565-73. doi: 10.1007/s00198-011-1668-0. Epub 2011 May 27.
Partial adherence in osteoporosis increases the risk for fragility fracture and has considerable impact on cost-effectiveness. This review highlights a number of avenues for further research, such as improved definition of thresholds of compliance and persistence, as well as gap length, offset times, and fraction of benefit.
A number of economic models have been developed to evaluate osteoporosis therapies and support decisions regarding efficient allocation of health care resources. Adherence to treatment is seldom incorporated in these models, which may reduce their validity for decision-making since adherence is poor in real-world clinical practice.
An ad hoc working group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis met to review key issues concerning the incorporation of partial adherence in health economic models.
Observational data have shown that poor adherence is associated with an increase in the risk for fragility fracture. Health economic modelling indicates that full adherence is associated with more quality-adjusted life years gained than partial adherence, as well as higher treatment costs and lower fracture-related costs. Although adherence appears as an important driver of cost-effectiveness, the effect is dependent on a range of other variables, such as offset time, fraction of benefit, fracture risk, fracture efficacy, fracture-related costs, and drug cost, some of which are poorly defined. Current models used to evaluate cost-effectiveness in osteoporosis may oversimplify the contributions of compliance and persistence.
Partial adherence has a significant impact on cost-effectiveness. Further research is required to optimise thresholds of compliance and persistence, the impact of gap length, offset times, and fraction of benefit.
骨质疏松症部分依从性增加脆性骨折风险，并对成本效益产生重大影响。本综述强调了一些进一步研究的途径，例如改善依从性和持久性的阈值定义，以及差距长度、偏移时间和获益分数。
许多经济模型已经被开发出来，用于评估骨质疏松症的治疗方法，并支持关于高效分配医疗资源的决策。这些模型很少纳入治疗依从性，这可能会降低其决策的有效性，因为在实际临床实践中，依从性较差。
欧洲临床和经济骨质疏松症和骨关节炎学会的一个特设工作组开会审查了将部分依从性纳入卫生经济模型的关键问题。
观察性数据表明，依从性差与脆性骨折风险增加有关。健康经济模型表明，完全依从性比部分依从性获得更多的质量调整生命年，以及更高的治疗成本和更低的骨折相关成本。尽管依从性似乎是成本效益的重要驱动因素，但这种影响取决于一系列其他变量，如偏移时间、获益分数、骨折风险、骨折疗效、骨折相关成本和药物成本，其中一些定义不明确。目前用于评估骨质疏松症成本效益的模型可能过于简化了依从性和持久性的贡献。
部分依从性对成本效益有重大影响。需要进一步研究以优化依从性和持久性的阈值、差距长度、偏移时间和获益分数的影响。
