Johnston, S.S.

Krege, J.H.

Krohn, K.

Mcmorrow, D.

Smith, D.

Zhao, Y.

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PMS53 Association Between Teriparatide Adherence and Health Care Utilization and Costs in Real World United States Kyphoplasty/Vertebroplasty Patients 

OBJECTIVES: Analyze drug use and related costs of a RA patient cohort in UNIMED
Rio de Janeiro affiliate (HMO).METHODS:All RA patient information of age, weight,
height, sex, body mass index (BMI) data and biologic DMARDs use were collected
from March/2009 to March/2011. Drugs ex-factory prices were used to estimate
treatment costs. RESULTS: Sixty-nine patients were treated in the period of anal-
ysis. The cohort profile was: 86.9% woman and 13.1% man, mean age 51 years,
mean weight 65.85kg, mean height 1.60m and mean BMI 24.31; 71.21% of patients
have been diagnosed for more than 5 years, 16.67% from 2 to 5 years and 12.12%, 6
months to 2 years. Mean non-biological DMARD use was 2.27 years. From March/
2009 to March/2010, 5 patients were treated with infliximab, 2 with etanercept, 5
with adalimumab, 5 with abatacept, 3 with tocilizumab and 4 with rituximab.
Estimated drugs costs were BRL398,943.56, BRL145,266.68, BRL385,933.60,
BRL325,719.00, BRL154,190.40 and BRL124,228.32 respectively, resulting in a total of
BRL1,534,281.56 (mean BRL63,928.40/patient). From April/2010 to March/2011, 14
patients were treated with infliximab, 1 with etanercept, 5 with adalimumab, 8
with abatacept, 5 with tocilizumab and 12 with rituximab. Drugs acquisition costs
were BRL1,117,041.98, BRL72,633.34, BRL385,933.60, BRL521,150.40, BRL256,984.00
and BRL372,684.96 respectively, resulting in a total of BRL2,726,428.28
(BRL60,587.30/patient). CONCLUSIONS: Considering first-line biologic DMARDs, to-
cilizumab therapy was estimated to be the less expensive. Mean costs per patient
decreased in 5.23% from first to second period of analysis mainly because of growth
in rituximab treatment usage (from 16.7% to 26.7%).
MUSCULAR-SKELETAL DISORDERS - Patient-Reported Outcomes & Patient
Preference Studies
PMS53
ASSOCIATION BETWEEN TERIPARATIDE ADHERENCE AND HEALTH CARE
UTILIZATION AND COSTS IN REAL WORLD UNITED STATES KYPHOPLASTY/
VERTEBROPLASTY PATIENTS
Zhao Y1, Johnston SS2, Smith D2, Mcmorrow D3, Krege JH1, Krohn K4
1Eli Lilly and Company, Indianapolis, IN, USA, 2Thomson Reuters, Washington, DC, USA,
3Thomson Reuters, Cambridge, MA, USA, 4Lilly USA, LLC, Indianapolis, IN, USA
OBJECTIVES: To examine the association between teriparatide adherence and
health care utilization and costs in “real world” U.S. kyphoplasty/vertebroplasty
(KV) patients. METHODS: A large U.S. administrative claims database was used to
identify patients aged 50 with a KV between January 1, 2002-December 31, 2010
(first observed KVindex). All patients included had 6 months of pre-index con-
tinuous enrollment, and no pre-index teriparatide, cancer, or Paget’s disease. Pa-
tients initiating teriparatide were followed for up-to 36 months post-index (fol-
low-up period), with censoring at switch to bisphosphonates, disenrollment, end of
study period, or having cancer or Paget’s disease. Three teriparatide adherence
(measured as the proportion of days covered [PDC] over the follow-up period) co-
horts were constructed: low (PDC0.5), medium (0.5PDC0.8), and high
(PDC0.8). Repeated KV and per-patient per-month (PPPM) number of inpatient
admissions and costs (total, inpatient, outpatient, and pharmacy) were compared
between cohorts. Multivariable generalized linear models were used to examine
the association between teriparatide adherence and health care utilization and
costs, adjusting for patient characteristics. RESULTS: The study sample included
1568 patients (mean age: 75 years; 82% female), with 403 (26%), 382 (24%), and 783
(50%) in the low, medium, and high adherence groups, respectively. Adjusting for
differences in patient characteristics, high adherence was significantly (P0.05)
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 increased pharmacy costs (low$752; medium$1,159; high$1,616) (all
P0.05), leading to similar total costs (low$3,344; medium$3,376; high$3,351)
between cohorts. The high adherence cohort also had the lowest (P0.05) odds of
repeated KV (odds ratio vs. high1.72 [low] and 1.73 [medium]) and number of
inpatient admissions (incidence rate ratio with base categoryhigh: low 1.61;
medium1.19). CONCLUSIONS: Among KV patients newly-initiating teriparatide,
significantly increased pharmacy costs associated with greater teriparatide adher-
ence were offset by significantly lower odds of repeated KV and significantly lower
medical resource use and costs.
PMS54
A RETROSPECTIVE COHORT STUDY OF PERSISTENCE & COMPLIANCE TO
TREATMENT FOR OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN IN HUNGARY
Lakatos P1, Tóth E2, Kovacs E2, Lang Z2, Psachoulia E3, Intorcia M3
1Semmelweis University, Budapest, Hungary, 2Healthware Consulting Ltd., Budapest, Hungary,
3Amgen (Europe) GmbH, Zug, Switzerland
OBJECTIVES: Low persistence and poor compliance with prescribed medication are
important factors in treatment failure. This study estimated persistence and com-
pliance of post-menopausal (PMO) women in Hungary. METHODS: This retrospec-
tive analysis used patients’ data from the National Health Insurance Fund Admin-
istration (NHIFA). Subjects were females, 50 years old with a diagnosis of
osteoporosis (with ICD-10 codes, M80 or 81), who started an osteoporosis drug
prescription between Jan 2004 and Dec 2010. Treatment persistence was estimated
per active substance and administration types for 12 and 24 months with a 4-week
grace period. Compliance was measured by Medication Possession Ratio (MPR) and
a patient was considered compliant with treatment at one year if MPR80%.
RESULTS: A total of 223,068 patients matched inclusion criteria, of whom 49.6%
were older than 70 years, 6.4% had prior fractures at first index date, 79.5% were on
oral bisphosphonates (OBPs), 8.2% on intravenous (IV) BPs and 12.3% on other
therapies. Persistence analysis with a 4-week grace period showed 27.0% and 68.7%
of patients persistent after 1 year for oral and parenteral drugs respectively. Sen-
sitivity analyses with grace period of 8 weeks (43.7% and 75.8%) and 12 weeks
(60.8% and 79.5%) increased persistence rates. The lowest persistence after 12
months was observed in daily (20.5%) and monthly (20.0%) compared to quarterly
(48.8%) drugs, declining at 24 months to 7.6%, 4.9%, 28.5% and 34.9% for daily,
monthly, quarterly and yearly drugs, respectively. Only 33.2% of all patients were
compliant with treatment (i.e. MPR80%). Compliance was higher to parenteral
drugs (73.5%) than oral drugs (29.5%). The lowest compliance was observed with
daily oral drugs (only 18.9%); weekly and monthly drugs had similar compliance of
31%. CONCLUSIONS: Persistence and compliance are very low in osteoporosis
treatment of PMO women in Hungary. However, parenteral, less frequently admin-
istered drugs have higher persistence and better compliance.
PMS55
A RETROSPECTIVE COHORT STUDY OF PERSISTENCE & COMPLIANCE TO
TREATMENT FOR OSTEOPOROTIC MEN IN HUNGARY
Lakatos P1, Tóth E2, Kovacs E2, Lang Z2, Psachoulia E3, Intorcia M3
1Semmelweis University, Budapest, Hungary, 2Healthware Consulting Ltd., Budapest, Hungary,
3Amgen (Europe) GmbH, Zug, Switzerland
OBJECTIVES: To estimate persistence and compliance with prescribed osteoporo-
sis medication in male patients in Hungary.METHODS: This retrospective analysis
used patient data from the National Health Insurance Fund Administration
(NHIFA). Subjects were males 50 years old with a diagnosis of osteoporosis
(ICD-10 code M80 or 81) who filled an initial osteoporosis drug prescription between
Jan 2004 and Dec 2010. Treatment persistence was estimated per active substance
and administration types for 12 and 24 months with a 4-week grace period. Com-
pliance was measured by Medication Possession Ratio (MPR) and a patient was
considered compliant with treatment at 1 year if MPR80%. RESULTS: Of 19,905
patients, who matched inclusion criteria, 47.7% were older than 70 years and 6.4%
had prior fractures at first index date; 99.0% were on oral bisphosphonates (OBPs),
0.9% on intravenous (IV) BPs and 0.1% on other therapies. Persistence analysis with
a 4-week grace period showed 26.1% of patients were persistent after 1 year for oral
drugs declining after 2 years to 10.5%. For parenteral drugs, 16.4% of patients were
persistent after 2 years. Sensitivity analyses with grace periods of 8 weeks (21.7%
for oral and 19.1% for parenteral drugs) and 12 weeks (34.7% for oral and 55.0% for
parenteral drugs) increased persistence rates at 2 years. The lowest persistence
after 12 months was observed in weekly (26.1%) & monthly (37.6%) drugs, reaching
after 24 months 10.5%, 37.6% & 16.4% for weekly, monthly and yearly drugs, re-
spectively. Only 27.8% of all patients were compliant with treatment (i.e.
MPR80%). Compliance was higher to parenteral drugs (100%) than oral drugs
(27.5%). CONCLUSIONS: Persistence and compliance with oral osteoporosis
treatments are very low in male patients in Hungary. However, parenteral,
less-frequently administered drugs are associated with higher persistence and
better compliance.
PMS56
IMPACT OF COMPLIANCE ON FRACTURE RISK FOR OSTEOPOROSIS IN
POSTMENOPAUSAL WOMEN IN HUNGARY
Lakatos P1, Tóth E2, Kovacs E2, Lang Z2, Psachoulia E3, Intorcia M3
1Semmelweis University, Budapest, Hungary, 2Healthware Consulting Ltd., Budapest, Hungary,
3Amgen (Europe) GmbH, Zug, Switzerland
OBJECTIVES: Compliance to osteoporosis drugs is frequently very low leading to
increased fracture risk in patients. This study examined the factors associated with
fracture risk of post-menopausal osteoporotic (PMO) patients in Hungary with key
interest in compliance. METHODS: This retrospective analysis used patients’ data
from the National Health Insurance Fund Administration (NHIFA). Subjects were
females, 50 years old with a diagnosis of osteoporosis (ICD-10 codes, M80 or 81),
who started an osteoporosis drug prescription between Jan 2004 and Dec 2010. The
relationship between all factors and fracture risk was assessed using a dynamic
Cox regression model and the Andersen-Gill analysis estimating 95% confidence
intervals. RESULTS:A total of 223,068 patients were analysed and 128,610 matched
inclusion criteria for the fracture risk analysis with 46.9% older than 70 years; 6.4%
had prior fractures at index date (i.e. the start of the analysis period). Analysis
showed that compliant patients have an 18% (RR0.82, CI0.75-0.89) fracture risk
reduction versus non-compliant patients. Moreover, patients older than 70 years
had an increase in fracture risk of 26% (RR1.26, CI1.15-1.38) compared to pa-
tients aged 50-60 years old. Prior fractures were associated with a two-fold in-
creased risk of a new fracture (RR2.01, CI1.76-2.30) and almost with a three-fold
increased fracture risk (RR2.91, CI2.37-3.58) in patients with one and 2 prior
fractures respectively compared to patients with no prior fractures. Moreover, a
relationship was found between any co-medication and fracture risk with a 9%
(RR1.09, CI1.00-1.20) increase with one co-medication and a 32% (RR1.32,
CI1.19-1.47) with 2 co-medications compared to none. CONCLUSIONS:Age, any
co-medication and prior fractures were associated with an increased relative risk
of fracture. Compliance, however, was associated with protection against fracture
(reduction of relative fracture risk).
PMS57
EFFECT OF DIFFERENT METHODS ON ESTIMATING PERSISTENCE TO ORAL
BISPHOSPHONATE THERAPY IN PORTUGUESE PMO PATIENTS – AN
OBSERVATIONAL PROSPECTIVE STUDY
Guerreiro J1, Torre C1, Mendes Z1, Machado M2, Ferreira I3, Feudjo-tepie M4, Canhão H5,
Branco J6, Miranda A1, Cristino J2
1INFOSAÚDE, Lisboa, Estremadura, Portugal, 2Amgen Portugal, Paço D’Arcos, Lisboa, Portugal,
3Amgen, Cambridge, Cambridge, UK, 4Amgen, Uxbridge, Uxbridge, UK, 5Faculdade de Medicina,
Universidade de Lisboa, Lisboa, Portugal, 6Faculdade de Ciências Médicas, Universidade Nova de
Lisboa, Lisboa, Lisboa, Portugal
OBJECTIVES: The use of historical or prospective cohorts of patients retrieved from
automated databases can provide different persistence estimates from self-re-
A449V A L U E I N H E A L T H 1 5 ( 2 0 1 2 ) A 2 7 7 – A 5 7 5


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PMS53 Association Between Teriparatide Adherence and Health Care Utilization and Costs in Real World United States Kyphoplasty/Vertebroplasty Patients

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