Cost-effectiveness of enhancing adherence with oral bisphosphonates treatment in osteoporotic women: an empirical approach based on healthcare utilisation databases

Objective Adherence with bisphosphonates therapy is generally low. Enhancing adherence with bisphosphonates would be effective in achieving the full benefits of therapy albeit a growth in the expenditure for supporting incremented drug use is expected. The cost-effectiveness of enhancing adherence with oral bisphosphonates in a large population of osteoporotic women has been assessed in the current study. Design Retrospective cohort study. Setting Healthcare utilisation databases of Lombardy Region, Italy. Participants A cohort of 28 558 women aged 45 years or more, resident in the Italian Region of Lombardy, who were newly treated with oral bisphosphonates during 2003-2004, was followed for 6 years after index prescription. Outcome measures Fracture-free survival time, healthcare cost and incremental cost-effectiveness ratio (ICER) of enhancing adherence, that is, the additional cost that would be spent every year for gaining one fracture-free year as a consequence of enhancing adherence at a certain level. Results Enhanced adherence from 33% (baseline) to 80%, increased both fracture-free survivals from 970 to 973 years and healthcare costs from euro118 000 to euro265 000 every 1000 woman-years, with ICER value of euro53 000 (95% CI euro49 000 to euro58 000). ICER values were lower for older women (euro50 000; 95% CI euro42 000 to euro58 000) and for those suffering from at least a chronic comorbidity (euro25000; 95% CI 95% CI euro7000 to euro47 000). Conclusions Enhancing adherence with oral bisphosphonates offers important benefits in reducing the risk of fracture, although at a substantial cost.