Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study.

INTRODUCTION: International guidelines on the treatment and prevention of osteoporosis recommend the use of bisphosphonates to prevent fractures in this population. However, low persistent use of bisphosphonates could considerably limit the prevention of fractures in clinical practice. OBJECTIVE: This study aimed to investigate the association between persistent use of bisphosphonates and the risk of osteoporotic fractures in clinical practice. METHODS: Data were obtained from the PHARMO Record Linkage System, which includes, among other databases, drug-dispensing records from community pharmacies linked to hospital discharge records of more than two million subjects in defined areas in the Netherlands. Persistence with bisphosphonate therapy was assessed during a period of 3 years. A nested matched case control study (cases:controls = 1:10) was performed to study the association between persistent bisphosphonate use and hospitalisation for osteoporotic fractures and analysed by conditional logistic regression analysis. The analyses were adjusted for patient characteristics such as previous hospitalisations for fractures, co-morbidity and co-medication. RESULTS: 14,760 new female users of bisphosphonates were identified of which 541 women had a hospitalisation for osteoporotic fracture after start of bisphosphonate treatment (1-3 years follow-up). One-year persistence rates increased from 33% with alendronate daily to 48% with alendronate weekly, an increase of 15%. Similar results were obtained with risedronate daily and weekly. One year persistent use of bisphosphonates resulted in a statistical significant 26% lower fracture rate (OR 0.74; 95%CI 0.57-0.95) whereas 2 year persistent use resulted in a 32% lower rate (OR 0.68; 95%CI 0.47-0.96). CONCLUSIONS: Persistent use of bisphosphonates decreases the risk of osteoporotic fractures in clinical practice. Approximately 6% of fractures among users of bisphosphonates could be prevented if persistence was improved by 20%. However, current persistence with bisphosphonate therapy is suboptimal and strategies that further increase persistence are likely to further prevent the number of fractures.

Utilisation pattern of fentanyl transdermal system in The Netherlands.

PURPOSE: To describe the utilisation pattern of TTS fentanyl in daily practice. METHODS: A retrospective cohort study was performed with data from the Dutch PHARMO system, including medication and hospital admission records of 850,000 inhabitants of 25 Dutch cities. New starters of TTS fentanyl with at least two consecutive prescriptions in the period of 1 January 1996 through 31 December 2001 were included in the study cohort. Patients were distinguished in having non-cancer or cancer pain. RESULTS: About 61% of the patients suffered from non-cancer pain and 60% used other opioids before start of TTS fentanyl. The majority of the patients used other pain medication during the first treatment episode. Most patients (74%) started treatment with the lowest dose of TTS fentanyl (25 microg/hour), patients with cancer pain more often started with higher doses. About half of the patients changed type of patch during the first treatment episode, 80% of these patients had an increase in dose of TTS fentanyl. Fifty percent of all patients had a first treatment episode of less than 2 months and more than one third did not renew their prescription within two months. The median number of days of use per patch was 2.2 days for all patients. CONCLUSIONS: The use of TTS fentanyl is limited to a short period of time for a substantial percentage of patients starting treatment. The median duration of use per TTS fentanyl patch i.e. 2.2 days, was lower than the 3 days application period recommended in the summary of product characteristics.

Persistence with inhaled corticosteroid therapy in daily practice.

OBJECTIVE: To quantify persistence with inhaled corticosteroids (ICS) among new users in daily practice and identify determinants of persistence. METHODS: A retrospective cohort study was performed with data from the Dutch PHARMO system. This system consists of medication and hospital admission records of 325,000 inhabitants of 12 Dutch cities. In patients who were already using other drugs with a labeled indication of obstructive lung diseases (ATC: R03), individuals with a first dispensing of ICS between January 1, 1994 and December 31, 2000 were identified. Persistence with ICS was defined as the number of days on ICS treatment in the first year of use. Determinants of persistence were identified one year before start of the first dispensing of ICS. RESULTS: Approximately 50% of the patients used inhaled corticosteroids (ICS) for less than 200 days, while 18% continued treatment for one year. One-year persistence rates increased to 40% in patients with a history of multiple respiratory disease related drugs. Persistence rates also increased with lower initial doses, if the initial prescription was instituted by a medical specialist, if a patient was previously hospitalized for obstructive lung diseases, and with increasing age. CONCLUSION: The persistence rate of ICS is poor. Preventing early treatment discontinuation may be important to ensure maximal benefit from ICS treatment.

[Rising costs of drugs in hospitals in the period 1996-2000 and over the next few years]. / Stijegende kosten van geneesmiddelen in ziekenhuizen in 1996-2000 en in de komende jaren.

OBJECTIVE: To obtain an impression of drug expenditure in hospitals and in particular the costs due to novel more expensive drugs both in the past and in the future. DESIGN: Descriptive. METHOD: Data on intramurally supplied drugs were collected from 6 of the 95 general hospitals, 5 of the 14 top clinical hospitals, 4 of the 8 university hospitals and I of the 13 categorical hospitals for the period 1 January 1996-31 December 2000. The data were extrapolated to the entire of the Netherlands per hospital category and per year on the basis of the adherence figures. The drug costs were calculated on the basis of cost prices. For the most important new potential drugs it was ascertained whether they would actually become available and if they would substantially contribute to the drug expenditure. RESULTS: In 2000, the total drug expenditure within all Dutch hospitals was estimated to be [symbol: see text] 402 million. A substantial part of the costs could be attributed to the use of anticancer drugs (19%) and antibiotics (14%). In 2000, about 12% of the drug expenditure could be attributed to the use of novel, expensive drugs. The total costs of drugs increased on average by 8% per year during the period 1996-2000. The contribution of novel, expensive drugs nearly doubled during this period, and anticancer drugs were the most significant factor in this. A large proportion of the potentially new drugs were innovative anticancer drugs and drugs used to treat immune diseases. These compounds are likely to be expensive. Based on these findings it is expected that over the next few years, drug expenditure within hospitals to grow by at least 20% per year.