Healthcare Costs Reduced When Osteoporosis Drugs Used Consistently, Study Says

Persistent use of osteoporosis medications was associated with reduced risk of fracture and significantly lower total healthcare costs. With direct medical costs of osteoporosis expected to reach $25.3 billion by 2025, both payers and patients would benefit from interventions aimed at improving medication persistence, a recent study in Osteoporosis International reported.

Poor medication persistence over time hinders successful management of a disease, other studies have reported. And another recent study found that more than 97,000 elderly patients with hip fractures found they were not often prescribed osteoporosis medications in an effort to prevent future fractures, and, in fact, the rates declined over 12 years.

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This study used Medicare claims data for the years 2009 to 2012 to examine the relationship between persistent osteoporosis medication use and fracture risk among female Medicare beneficiaries diagnosed with osteoporosis.

The study included 294,369 patients; 32.9% were persistent osteoporosis medication users and 67.1% were nonpersistent (having less than 12 months of continuous use). Persistent medication use was defined as continuous use (no gap ≥60 days) for 1 year or longer.

Fracture incidence rates were 16.2 per 100 patient-years preinitiation and 4.1 postinitiation for persistent users; corresponding rates for nonpersistent users were 19 and 7.3 per 100 patient-years. The adjusted post/preinitiation fracture rate ratios were 0.284 for persistent and 0.411 for nonpersistent users. The ratio of the 2 rate ratios was 0.692 (persistent vs nonpersistent, P < .0001), suggesting a significantly greater fracture rate reduction for persistent users.

Persistent patients had fewer comorbid conditions, fewer hospitalizations, and lower medical costs, but more bone mineral density tests.

Total healthcare costs (defined as per person per year, or PPPY) were significantly lower for the persistent group than for the nonpersistent group (adjusted cost ratio 0.888 vs 0.973; P < .0001). Lower inpatient and fracture-related costs drove this trend. Outpatient costs and oral medication costs were slightly higher for the persistent group.

Emergency department costs trended lower for the persistent group, but the results were not statistically significant ($260 vs $352 PPY, P = 0.2322).

Twelve months of persistent osteoporosis medication use was associated with an 8.7% reduction in total costs, indicating that, on average, each persistent patient saved $1379 each year. There was a 22% reduction in inpatient costs and a 32% reduction in fracture-related medical costs, while outpatient costs increased by only 8%.

Twelve months of 12 months of persistent osteoporosis medication use was associated with a 31% reduction in any fracture, 41% reduction in hip fracture, 30% reduction in vertebral fracture, and 17% reduction in non-hp, non-vertebal fracture.

Reference

Liu J, Guo H, Rai P, Pinto L, Barron R. Medication persistence and risk of fracture among female Medicare beneficiaries diagnosed with osteoporosis. [published online July 18, 2018]. Osteoporos Int. doi:10.1007/s00198-018-4630-6.