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A retrospective analysis of extended-interval dosing and the impact on bisphosphonate compliance in the US Military Health System

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Abstract

Summary

This study evaluated whether patients treated with bisphosphonates in the US Military Health System were more compliant with treatment given monthly versus weekly. While medication compliance did improve with treatment given monthly, overall compliance with bisphosphonates was still suboptimal suggesting the need for further strategies to improve compliance with treatment for osteoporosis.

Introduction

The study objective was to evaluate the relationship between bisphosphonate dosing interval and medication compliance among new users initiating oral bisphosphonates.

Methods

We conducted a retrospective observational cohort study of administrative claims data in the US Military Health System to examine medication compliance among 22,363 new users of oral bisphosphonates starting weekly (68%) or monthly (32%) therapy. Medication compliance during the first year of treatment was measured using two methods: (1) medication possession ratio (MPR) with compliance defined as ≥80% of days covered and (2) time to first gap of more than 30 days following initiation. Logistic regression and a proportional hazards model were used to detect differences in medication compliance between cohorts.

Results

After the first year of therapy, 57% of subjects were not compliant with bisphosphonates (MPR <80%), while 84% experienced a gap in treatment of more than 30 days. After adjustment for study covariates, the odds of a patient being compliant with treatment was 21% higher among monthly users compared to weekly users (OR 1.207, 95% confidence interval (CI) 1.119–1.257). Similarly, the risk of experiencing a 30-day gap in treatment was 6% lower among monthly users compared to weekly users (HR 0.934, 95% CI 0.905–0.964).

Conclusions

Patients receiving oral bisphosphonates on a monthly basis showed higher rates of medication compliance compared to weekly dosing in our study. However, compliance with bisphosphonates among all new users was suboptimal, suggesting the need for improved strategies to enhance compliance with oral bisphosphonates in the US Military Health System.

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Acknowledgments

The authors gratefully acknowledge Deborah Garcia for administrative and technical support during the drafting of this manuscript.

Disclaimer

The thoughts and opinions expressed in this paper are those of the authors and do not necessarily represent the official policy or position of TRICARE Management Activity, the Department of Defense, or the US Government.

Conflicts of interest

None.

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Authors and Affiliations

  1. TRICARE Management Activity (TMA), Pharmacoeconomic Center, 4130 Stanley Road, Bldg 1000, Fort Sam Houston, San Antonio, TX, 78234, USA

    J. Devine, S. Trice, Z. Finney, S. Yarger, E. Nwokeji & A. Linton

  2. TRICARE Management Activity (TMA), Pharmacy Operations Directorate, 5111 Leesburg Pike, Suite 810, Falls Church, VA, 22041, USA

    W. Davies

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  1. J. Devine
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  2. S. Trice
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Correspondence to J. Devine.

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Devine, J., Trice, S., Finney, Z. et al. A retrospective analysis of extended-interval dosing and the impact on bisphosphonate compliance in the US Military Health System. Osteoporos Int 23, 1415–1424 (2012). https://doi.org/10.1007/s00198-011-1729-4

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  • DOI: https://doi.org/10.1007/s00198-011-1729-4

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