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Adherence to osteoporosis medicines in Estonia—a comprehensive 15-year retrospective prescriptions database study

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Abstract

Summary

Some patients do not take medicines as they are supposed to. Our research showed that in Estonia, one fifth of patients did not start treatment with osteoporosis medicines and only 20% used the medicines for at least 3 years as they should. This induces unnecessary costs to the healthcare system.

Purpose

Medication non-adherence is the number one reason for not obtaining the expected clinical effect of medicines. With osteoporosis treatment, it has been shown that both implementation of treatment and persistence influence the risk of fractures significantly. Long-term adherence to medication in Estonia is to be determined with this study.

Methods

A 15-year retrospective study was carried out in order to establish initiation, implementation, and persistence of Estonian patients. All new users of osteoporosis medicines were analyzed for all prescriptions they received during the study period. Sufficient adherence to treatment was defined as a patient being dispensed 80% or more prescribed doses for at least 1 year.

Results

The study period was from 2001 to 2015. Patients (24,652) were included in the study. Of the patients, 93.7% (n = 23,091) were women and 6.3% (n = 1564) were men. Eighteen percent (4636) were dispensed only one prescription. Of the patients, 44.2% included in the study had medication possession ratio (MPR) ≥80% over follow-up period; 8922 (36.2%) who were prescribed from 2001 to 2015 persisted for 1 year with MPR ≥80% and 19.8% persisted for 3 years. Forty percent of expenditure on osteoporosis medication was made for treatment courses with insufficient adherence.

Conclusions

There is room for improvement in Estonia with medication adherence relating to all three aspects that determine adherence—initiation, implementation, and persistence. This means further efforts are to be made to educate patients and healthcare professionals on realizing the importance of good adherence.

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Authors and Affiliations

  1. Department of Traumatology and Orthopedics, University of Tartu, Institute of Clinical Medicine, L.Puusepa 8, Tartu, Estonia

    Ott Laius, Katre Maasalu & Aare Märtson

  2. Estonian State Agency of Medicines, Nooruse 1, 50411, Tartu, Estonia

    Ott Laius

  3. Department of Epidemiology and Biostatistics, University of Tartu, Institute of Family Medicine and Public Health, Ravila 19, Tartu, Estonia

    Heti Pisarev

  4. Tartu University Hospital, Traumatology and Orthopaedics Clinic, L. Puusepa 8, Tartu, Estonia

    Katre Maasalu & Aare Märtson

  5. Department of Pathophysiology, University of Tartu, Institute of Biomedicine and Translational Medicine, Ravila 19, Tartu, Estonia

    Sulev Kõks

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  1. Ott Laius
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Contributions

Ott Laius, Heti Pisarev, Katre Maasalu, Sulev Kõks, and Aare Märtson declare that all authors read and approved the manuscript.

Corresponding author

Correspondence to Ott Laius.

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Funding source

The research leading to these results has received institutional research funding (IUT 20–46) of the Estonian Ministry of Education and Research and the European Union Seventh Framework Programme FP7/2007–2013 under grant agreement No. 602398 (collaborative project HypOrth).

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Laius, O., Pisarev, H., Maasalu, K. et al. Adherence to osteoporosis medicines in Estonia—a comprehensive 15-year retrospective prescriptions database study. Arch Osteoporos 12, 59 (2017). https://doi.org/10.1007/s11657-017-0354-z

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