Association Between Gastrointestinal Events and Health Care Resource Utilization Among Patients with Osteoporosis: Analysis of a U.S. Managed Care Population.

Journal Article (Journal Article)

BACKGROUND: Among patients on osteoporosis therapy, including oral bisphosphonates (BIS), upper gastrointestinal (GI) conditions have been linked with lower adherence to treatment and increased treatment discontinuation in clinical practice. Patients who are nonadherent to treatment have a higher risk of osteoporotic fractures and, consequently, have greater use of health care services. The burden of upper gastrointestinal events on health care resource utilization (HCRU) among women initiating oral BIS has not been well investigated. OBJECTIVE: To examine the association of upper GI events and HCRU in women initiating oral BIS.  METHODS: Using a U.S. national claims database, this retrospective study identified women aged ≥ 55 years who were prescribed oral BIS during 2001-2011 and had no history of GI events 12 months prior to treatment initiation. Patients with medical claims for an upper GI event ≤ 4 months posttreatment initiation were cases; all others were controls. The date of the first upper GI event among cases and a randomly assigned date ≤ 4 months posttreatment initiation among controls was the index date. Cases were matched 1:1 to controls by propensity scores derived from logistic regression of pre-index patient characteristics. Outcomes were all-cause and osteoporosis (OP)-related HCRU in the 6-month post-index period. Differences were assessed using McNemar's test. RESULTS: Of the 62,863 eligible patients, 4,751 (7.6%) experienced an upper GI event ≤ 4 months posttreatment initiation (cases); 4,739 cases were matched with 4,739 controls. Compared with controls, cases had higher rates of all-cause HCRU (outpatient: 99.3% vs. 87.8%; inpatient: 20.2% vs. 6.4%; emergency room [ER]: 12.5% vs. 7.4%; all P  less than  0.0001) and OP-related HCRU (outpatient: 24.6% vs. 18.2%; inpatient: 3.4% vs. 1.0%; ER: 0.7% vs. 0.4%; all P  less than  0.05). CONCLUSIONS: Patients with upper GI events had higher rates of all-cause and OP-related health care utilization. Upper GI events may pose an incremental HCRU burden among patients initiating BIS.

Full Text

Duke Authors

Cited Authors

  • Modi, A; Gold, DT; Yang, X; Fan, C-PS; Sajjan, SG

Published Date

  • September 2015

Published In

Volume / Issue

  • 21 / 9

Start / End Page

  • 811 - 821

PubMed ID

  • 26308228

Electronic International Standard Serial Number (EISSN)

  • 2376-1032

Digital Object Identifier (DOI)

  • 10.18553/jmcp.2015.21.9.811


  • eng

Conference Location

  • United States