Scotti Lorenza, Arfè Andrea, Zambon Antonella, Merlino Luca, Corrao Giovanni
Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
BMJ Open. 2014 Mar 24;4(3):e003758. doi: 10.1136/bmjopen-2013-003758.
Adherence with bisphosphonates therapy is generally low. Enhancing adherence with bisphosphonates would be effective in achieving the full benefits of therapy albeit a growth in the expenditure for supporting incremented drug use is expected. The cost-effectiveness of enhancing adherence with oral bisphosphonates in a large population of osteoporotic women has been assessed in the current study.
Retrospective cohort study.
Healthcare utilisation databases of Lombardy Region, Italy.
A cohort of 28 558 women aged 45 years or more, resident in the Italian Region of Lombardy, who were newly treated with oral bisphosphonates during 2003-2004, was followed for 6 years after index prescription.
Fracture-free survival time, healthcare cost and incremental cost-effectiveness ratio (ICER) of enhancing adherence, that is, the additional cost that would be spent every year for gaining one fracture-free year as a consequence of enhancing adherence at a certain level.
Enhanced adherence from 33% (baseline) to 80%, increased both fracture-free survivals from 970 to 973 years and healthcare costs from €118 000 to €265 000 every 1000 woman-years, with ICER value of €53 000 (95% CI €49 000 to €58 000). ICER values were lower for older women (€50 000; 95% CI €42 000 to €58 000) and for those suffering from at least a chronic comorbidity (€25000; 95% CI 95% CI €7000 to €47 000).
Enhancing adherence with oral bisphosphonates offers important benefits in reducing the risk of fracture, although at a substantial cost.
双膦酸盐治疗的依从性普遍较低。提高双膦酸盐的依从性虽预计会增加支持更多药物使用的支出，但对充分实现治疗益处是有效的。本研究评估了在大量骨质疏松女性中提高口服双膦酸盐依从性的成本效益。
回顾性队列研究。
意大利伦巴第地区的医疗保健利用数据库。
2003年至2004年期间在意大利伦巴第地区新接受口服双膦酸盐治疗的28558名45岁及以上女性队列，在索引处方后随访6年。
无骨折生存时间、医疗成本以及提高依从性的增量成本效益比（ICER），即因在一定水平提高依从性而每年为获得一个无骨折年份所额外花费的成本。
依从性从33%（基线）提高到80%，每1000名女性每年的无骨折生存时间从970年增加到973年，医疗成本从118000欧元增加到265000欧元，ICER值为53000欧元（95%可信区间49000欧元至58000欧元）。老年女性（50000欧元；95%可信区间42000欧元至58000欧元）以及患有至少一种慢性合并症的女性（25000欧元；95%可信区间7000欧元至47000欧元）的ICER值较低。
提高口服双膦酸盐的依从性在降低骨折风险方面具有重要益处，尽管成本高昂。
