Patient characteristics and utilization of breast cancer screening or diagnostic procedures prior to initiation of raloxifene, bisphosphonates and calcitonin

Abstract

Objective:

This study evaluated the characteristics of postmenopausal women who initiated on raloxifene, bisphosphonates, and calcitonin, specifically evaluating the use of breast cancer screening or diagnostic procedures prior to initiation of therapy.

Research design and methods:

Women 50 years and older with at least one claim for raloxifene (RLX), bisphosphonates (BIS), or calcitonin (CT) in 2005 or 2006 and continuous enrollment (with consecutive gaps in enrollment of no more than 1 month) from January 2004 to December 2007 were identified in a large national commercial and Medicare claims database. Treatment-naïve postmenopausal women initiating on raloxifene, bisphosphonates, and calcitonin were compared in terms of breast cancer screening or diagnostic procedures (i.e., mammogram, breast MRI, ultrasound, and biopsy) as well as age, provider specialty, fractures, bone mineral density screening, Chronic Disease Scores, and comorbidities.

Results:

Treatment-naïve patients initiated on raloxifene were younger than those initiated on bisphosphonates and calcitonin (mean age 63 years [RLX], 66 years [BIS], 72 years [CT]; p < 0.05). Treatment-naïve patients initiated on raloxifene were more likely to have had breast cancer screening or diagnostic procedures in the 12 months prior to therapy initiation than treatment-naïve bisphosphonate or calcitonin patients (RLX 61%, BIS 57%, CT 41%; p < 0.05), and were more likely to have an increased frequency of mammograms in the 12 months after therapy initiation (RLX 18%, BIS 16%, CT 15%; p < 0.05). Calcitonin patients were the most likely to have had a fracture in the pre-period followed by bisphosphonates then raloxifene patients.

Conclusion:

These data suggest that there are differences in the clinical characteristics of postmenopausal women who initiate osteoporosis medications specifically in regards to age, pre-period fractures and breast cancer screening or diagnostic procedure use prior to initiation. Key limitations include general claims database limitations, lack of ability to assess behavior change, and lack of information on therapy initiation rationale.

Key words:

• Bisphosphonates
• Breast cancer
• Calcitonin
• Osteoporosis
• Postmenopausal
• Raloxifene

Transparency

Declaration of funding

This study was funded by Eli Lilly and Company.

Declaration of financial/other relationships

S.A.F., B.M., D.M., and J.L.M. are all employees and stockholders of Eli Lilly and Company. A.W., R.K. and G.V. are all employees of ZS Associates. Eli Lilly and Company contracted with ZS Associates to conduct this analysis and with i3 Statprobe on the technical writing of this manuscript. Peer reviewers may receive honoraria from CMRO for their review work. Peer reviewer 1 has disclosed that he/she is a consultant/advisor, on regulatory issues, to Prime Medica; and is a shareholder in and former employee of AstraZeneca. Peer reviewer 2 has disclosed no relevant financial relationships.

Acknowledgments

The authors wish to thank Abhinav Khare and Dr Shankar Viswanathan, ZS Associates employees, for assistance with the data analysis. The authors also wish to thank Dr Jarrett Coffindaffer and Ms. Teri Tucker, i3 Statprobe employees, for writing and editorial assistance.

Notes

*MarketScan is a registered trademark of The MEDSTAT Group, Inc, Ann Arbor, MI, USA.

*Prempro and Premarin are registered trade names of Wyeth Pharmaceuticals, Philadelphia, PA, USA.