The importance of integrating medication adherence into pharmacoeconomic analyses: the example of osteoporosis

Figures & data

Figure 1. Impact of medication nonadherence on the clinical effectiveness (expressed as number of fractures prevented and quality-adjusted life-years gained) of oral bisphosphonates.

Using a simulation model, this study estimated the lifetime effectiveness per patient at real-world adherence levels and full adherence with oral bisphosphonate compared with no treatment. Analysis was conducted in Belgian patients aged 55–85 years, either with a bone mineral density T-score ≤-2.5 or a prevalent vertebral fracture at baseline. Medication nonadherence decreased by 61 and 59% for the number of fractures prevented and the QALY gain of oral bisphosphonates compared with the full adherence scenario, respectively.

QALY: Quality-adjusted life-year.

Data taken from [4].

Figure 2. Impact of medication nonadherence on aggregated and disaggregated (drug and disease) healthcare costs.

Using a simulation model, this study estimated the aggregated and disaggregated costs associated with oral bisphosphonate therapy at real-world adherence and full adherence levels in comparison with no treatment. Analysis was conducted in Belgian patients aged 55–85 years either with a bone mineral density T-score ≤-2.5 or a prevalent vertebral fracture at baseline. Aggregated costs (total costs) include the costs of therapy (drug and monitoring costs) and fracture-related costs (disease costs).

Data taken from [4].

Figure 3. Impact of medication nonadherence on the cost–effectiveness (expressed as cost in euros per quality-adjusted life-year gained) of oral bisphosphonates compared with no treatment.

This figure (called the ‘cost–effectiveness plane’) presents the incremental effectiveness and costs of oral bisphosphonates compared with no treatment at real-world and full adherence levels. The incremental cost–effectiveness ratio is represented by the slope of the line from the origin. The analysis was conducted in Belgian patients aged 55–85 years either with a bone mineral density T-score ≤-2.5 or a prevalent vertebral fracture at baseline.

QALY: Quality-adjusted life-year.

Data taken from [4].

Table 1. Maximum cost per year for an adherence-enhancing intervention to be considered cost effective.

Adherence improvement (%)	Maximum cost per year
	Sweden, 2009[30]†	Belgium, 2010[4]‡	Ireland, 2012[45]‡
10	€225	€73	€119
25 (30 for Sweden)	€676	€149	€299
50	€1130	€239	€726

^†Cost–effectiveness threshold of €60,000 per quality-adjusted life-year gained.

^‡Cost–effectiveness threshold of €45,000 per quality-adjusted life-year gained.

Hiligsmann M, Rabenda V, Bruyere O et al. The clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients. Health Policy96, 170–177 (2010).

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Ström O, Borgström F, Kanis JA et al. Incorporating adherence into health economic modelling of osteoporosis. Osteoporos. Int.20, 23–34 (2009).

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Hiligsmann M, McGowan B, Bennett K et al. The clinical and economic burden of poor adherence and persistence with osteoporosis medications in Ireland. Value Health (2012) (In press).

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