Utilization of osteoporosis medicines, medication adherence and the trend in osteoporosis related hip fractures in Estonia

Abstract

Osteoporoos on krooniline haigus, mida iseloomustab luukoe ainevahetusprotsesside kaldumine luukoe lammutamise poole võrreldes luukoe moodustumisega. Sellest tulenevalt muutuvad inimese luud nõrgaks ning võivad kergesti murduda. Osteoporoosi raviks on olemas efektiivsed ravimid, mis tugevdavad patsientide luukude ning aitavad selle kaudu ära hoida luumurdude teket. Rahvusvahelistest kliinilistest uuringutest teame, et edukas luumurdude arvu vähendav osteoporoosiravi on pikaajaline ning peaks vältama vähemalt kolm aastat. Kuid kõik patsiendid ei võta ravimeid nii nagu arst on neile määranud. Seda, kuidas patsient arsti poolt välja kirjutatud ravimeid tarvitab ning etteantud annustamise skeemi täidab nimetatakse ravijärgimuseks. Madal ravijärgimus on peamine põhjus, miks patsiendid ei saa ravimitest loodetud kasu. Piisavaks peetakse vähemalt 80% ettenähtud raviannuste võtmist, et osteoporoosiravimi kontsentratsioon patsiendi veres oleks vajalikul tasemel ja ravi tulemus efektiivne. Käesolev doktoritöö uuris osteoporoosiravimite kasutamist, ravijärgimust ning võimalikku mõju osteoporoosist tingitud luumurdude trendile Eestis. Tuvastati, et osteoporoosiravimite kasutamine tõusis oluliselt 2000ndate aastate keskel ning sellele järgnevatel aastatel hakkas reieluu proksimaalse osa murdude arv vähenema. Samuti leiti, et osteoporoosiravimite üldine kasutamine ning keskmine ravimi päevadoosi maksumus muutusid uuringu vältel erisuunaliselt. Viidates, et ravimite hinna langus mõjutab positiivselt ravimite kasutamise üldist taset Ligikaudu 25% patsientidest ei alustanud osteoporoosi ravi ja ei ostnud välja juba esimest retsepti või ostsid ravimi välja ainult ühe retseptiga. 36% ravi alustanud patsientidest võttis vähemalt 80% neile määratud raviannustest vähemalt ühe aasta vältel ning ainult 20% patsientidest tegi seda kolme aasta vältel. Osteoporoosiravimitele tehtud kulutustest 40% läks patsientide raviks, kes ei võtnud piisavat hulka raviannuseid (vähemalt 80%) või kelle ravikuuri pikkus oli alla aasta ning seega ei saanud ravist oodatavat kasu.

Osteoporosis is a chronic condition that is characterized by the disruption in the balance of bone metabolism. Loss of bone mass leaves bones more fragile and susceptible to fractures. There are effective medicines available to treat osteoporosis and strengthen bones. It has been established in clinical trials that treatment with these medicines has to last for at least three years for them to be effective. Unfortunately all patients do not take their medicines as instructed by their doctor. The rate to which patients follow instructions is referred to as medication adherence. Medication non-adherence is the number one reason why patients do not achieve the health benefits from medicines hoped for. With osteoporosis medicines it is regarded as sufficient when a patient takes at least 80% of the prescribed doses for the concentration of medicine in blood to be high enough and for the drug to be effective. The current thesis studied the utilization of drugs, adherence to osteoporosis medicines and the possible influence on osteoporosis related hip fractures in Estonia. It was established that the consumption of osteoporosis medicines increased very quickly in the middle of the 2000s and was followed by a decrease in the trend of hip fractures in a couple of years. The trends of general consumption of osteoporosis medicines and the average daily dose price of these medicines moved in opposite directions. This suggests that consumption is affected at least in part by the price of medicines. About 25% of patients did not start osteoporosis treatment and did not purchase their first prescription or purchased medicines with only one prescription. 36% of patients who started treatment took more than 80% of doses they were supposed to and persisted with treatment for at least one year and 20% of patients did so for at least three years. 40% of the total expenditure on osteoporosis medicines in Estonia was made for the treatment of patients who did not take more than 80% of the prescribed doses or did not persist with treatment for at least a year meaning they probably did not achieve the effect of medicines hoped for when they were prescribed.