Orlando, Valentina (2015) Persistence to therapy and risk of fracture in patients treated with antiosteoporotic drugs: analysis of costs and consequences. [Tesi di dottorato]

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Medication non-adherence is an important public health concern, affecting health outcomes and overall health care costs. Adherence is becoming a priority included in the political agenda of health care system. In 2012 was launched from EC the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA). The EIP-AHA A1 Action Group is focused on prescription and adherence. Part of the results of this thesis have been made available to A1 Action Group as preliminary data that might be useful for the further focused interventions. This thesis aims to provide more evidence on relation between poor adherence and adverse outcomes and to define reason of poor adherence, by using drug-utilization approaches using different sources of health-related automated databases. The scope of the study is also to evaluate economic impact of enhancing adherence by using real-life approach. The case study is population exposure to anti-osteoporotic drugs: with ageing populations, the burden of osteoporotic fractures on society will increase in the coming years and the prevention of osteoporotic fractures is therefore a major public health issue. The results showed sub optimal level of persistence and drug regimen is one of the strong predictors of non-adherence. Gender influences adherence to therapy and this is an issue that could be taken in strong consideration in tailor intervention to improve adherence. Another aspect is comorbidity this highlighted that an approach centered on comorbidity/multimorbidity, could be more pertinent, in particular when address health issues concerning older people. The ICER , expressed in terms of cost/fracture avoided equals € 821. This value indicates the cost that the NHS should support each fracture avoided This thesis demonstrated the potential of the use of existing data sources to evaluate appropriateness of drug use. Drugs cost money to buy, but if we use them in an appropriate way we can also save costs in other areas. In particular enhancing adherence to medication may lead to reductions in the number of patients requiring hospitalization. This research only explored cost effectiveness of improve adherence in drug use for osteoporosis, but clearly many different pattern of drugs for chronic conditions could be assessed in a similar way.

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