Computer simulation models economic savings from adherence to osteoporosis medications

Most osteoporosis patients are aware of the individual physical impact of sticking to their treatment regimen, but it can be harder to conceptualize the economic savings that broad adherence to medications can have.

For this reason, researchers at Brigham and Women’s Hospital in Boston, Massachusetts, recently conducted a study into the potential consequences of implementing a widespread behavioral intervention to get women with osteoporosis to improve their adherence to bisphosphonates.

The results, which appeared in the Journal of Clinical Endocrinology and Metabolism, indicated that even a simple patient-level intervention can dramatically increase a treatment's cost-effectiveness.

What behavioral intervention did the team attempt to implement? None.

Instead, scientists used statistical modeling to project what the ramifications of a hypothetical intervention might be. The actual method was unspecified, though the team said several specific doctor-patient mediations achieved significant success in prior reports.

Possibly the most effective of these previously studied interventions was a counseling session between nurses and osteoporosis patients, as described in the journal Osteoporosis International.

In the new study, researchers simply used statistical software to forecast the effects of implementing a hypothetical intervention, which they defined as costing $250 per patient and resulting in a 30 percent reduction in the number of patients who stop taking bisphosphonates.

The results were relatively dramatic.

Researchers determined that, among 65-year-old women on bisphosphonates, such a program would improve the medication's cost-effectiveness by nearly $30,000 per quality-adjusted year of life.

Likewise, most projections determined that intervention to improve adherence could increase cost-effectiveness by up to $50,000 per quality-adjusted life-year.

Scientists validated these figures by calibrating the statistical model with age- and gender-based 10-year fracture risks that match those measured by public health agencies in the U.S.

These findings suggest that even a relatively inexpensive behavioral intervention can improve the cost-effectiveness of pharmaceutical osteoporosis regimens. In fact, researchers suggested that nurse-patient interviews might strengthen adherence to bisphosphonates with more doses per year.

"One potential implication is that some patients currently being prescribed drugs with a less frequent dosing interval could instead be given medications requiring more frequent dosing coupled with an adherence intervention," the team concluded.

Since osteoporosis often has no symptoms, patients may easily forget to stick to their medications, the International Osteoporosis Foundation (IOF) warns. This non-adherence can be exacerbated by the lack of any perceived effect of bisphosphonates.

As an illustration of the severity of this problem, the IOF states that between 50 and 75 percent of all women who initiate an osteoporosis medication are non-compliant within just one year.