Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Osteoporos Int. 2013 Sep;24(9):2525-33. doi: 10.1007/s00198-013-2324-7. Epub 2013 Mar 26.
The objective of this study was to examine the association between teriparatide adherence and healthcare utilization and costs in real-world US kyphoplasty/vertebroplasty (KV) patients. Among KV patients newly initiating teriparatide, significantly increased pharmacy costs associated with high teriparatide adherence were offset by significantly lower inpatient utilization and medical costs.
This study seeks to examine the association between teriparatide adherence and healthcare utilization/costs in real-world US KV patients.
Identified patients from a large US administrative claims database were aged 50+ with KV from 1/1/2002-12/31/2010 (first observed KV = index). Included individuals had 6+ months of pre-index continuous enrollment and no pre-index teriparatide, cancer, or Paget's disease. Follow-up period for patients initiating teriparatide was ≤36 months post-index. Three teriparatide adherence cohorts were constructed using the proportion of days covered (PDC) during the follow-up period: low (PDC ≤ 0.5), medium (PDC >0.5-≤ 0.8), and high (PDC >0.8). Repeated KV admissions, any inpatient admission, number of inpatient admissions, and per-patient-per-month (PPPM) inpatient, outpatient, pharmacy, and total costs were compared between cohorts. The associations between teriparatide adherence and healthcare utilization/costs were examined using multivariable regression models, adjusting for patient demographics and clinical characteristics.
Included were 1,568 patients (mean age, 75 years; 82% female): 403 (26%) had low adherence, 382 (24%) medium, and 783 (50%) high. After multivariable adjustment, high adherence was significantly associated with the lowest PPPM inpatient (low = $1,287; medium = $1,005; high = $678) and outpatient (low = $1,464; medium = $1,244; high = $1,077) medical costs, but with increased pharmacy costs (low = $752; medium = $1,159; high = $1,616; all P < 0.05), leading to similar total costs (low = $3,344; medium = $3,376; high = $3,351) between cohorts; high adherence was also significantly associated with the lowest odds of repeated KV admission, any inpatient admission, and number of inpatient admissions (all P < 0.05).
Among KV patients initiating teriparatide, significantly increased pharmacy costs associated with high teriparatide adherence were offset by significantly lower inpatient utilization and medical costs.
本研究旨在探讨特立帕肽在真实世界美国椎体后凸成形术/椎体成形术（KV）患者中的应用与医疗保健利用和成本之间的关系。在新开始特立帕肽治疗的 KV 患者中，高特立帕肽依从性相关的显著较高的药房成本，被显著较低的住院利用率和医疗成本所抵消。
本研究旨在探讨特立帕肽在真实世界美国 KV 患者中的应用与医疗保健利用/成本之间的关系。
从一个大型美国行政索赔数据库中确定了年龄在 50 岁及以上、2002 年 1 月 1 日至 2010 年 12 月 31 日接受 KV（首次观察到的 KV=索引）的患者。纳入标准为：至少有 6 个月的索引前连续入组，且索引前无特立帕肽、癌症或佩吉特病。开始特立帕肽治疗的患者的随访期为≤36 个月。使用随访期间的比例天数覆盖（PDC）构建了三个特立帕肽依从性队列：低（PDC≤0.5）、中（PDC>0.5-≤0.8）和高（PDC>0.8）。比较了不同队列之间的重复 KV 入院、任何住院入院、住院入院次数以及每个患者每月（PPPM）的住院、门诊、药房和总费用。使用多变量回归模型，调整患者的人口统计学和临床特征，检查了特立帕肽依从性与医疗保健利用/成本之间的关联。
共纳入 1568 例患者（平均年龄 75 岁；82%为女性）：403 例（26%）依从性低，382 例（24%）中，783 例（50%）高。多变量调整后，高依从性与最低的 PPPM 住院（低=1287 美元；中=1005 美元；高=678 美元）和门诊（低=1464 美元；中=1244 美元；高=1077 美元）医疗费用显著相关，但药房费用增加（低=752 美元；中=1159 美元；高=1616 美元；均 P<0.05），导致各队列之间的总费用相似（低=3344 美元；中=3376 美元；高=3351 美元）；高依从性也与重复 KV 入院、任何住院入院和住院入院次数的最低几率显著相关（均 P<0.05）。
在开始特立帕肽治疗的 KV 患者中，与高特立帕肽依从性相关的显著较高的药房成本，被显著较低的住院利用率和医疗成本所抵消。
