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Measuring the effectiveness of osteoporosis prescription medications using population-based administrative health databases.

机译：使用基于人群的行政健康数据库来评估骨质疏松症处方药的有效性。

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摘要

Introduction. The 'real-world' effectiveness of osteoporosis prescription medications for the prevention and treatment of osteoporosis cannot be determined from randomized clinical trials. Using data from administrative health databases, this thesis presents a retrospective observational study methodology to specifically measure the risk of osteoporosis-related fractures in women treated outside the clinical trial arena (i.e. in the 'real-world'). However, several factors related to the receipt of a prescription therapy prevent the direct comparison of outcomes between treated and untreated individuals. This dissertation attempts to identify these factors and ultimately apply this information to an overall 'drug effectiveness' model.; Methods. Using population-based administrative health databases, a cohort of women over 50 years of age was identified. Pharmaceutical claims data from 1996 through 2002 were analyzed to identify new users of osteoporosis prescription medications (OSRx). Three separate Cox proportional hazards regression analyses were conducted to identify the factors associated with (a) the likelihood of initiating an OSRx; (b) the likelihood of receiving a bone mineral density (BMD) assessment; and (c) the likelihood of discontinuing treatment. Given the factors identified in each of these analyses, a propensity score was developed to stratify women according to their likelihood to initiate an OSRx, and a final stratified Cox proportional hazards model was developed to estimate the overall effect of OSRx treatment on fracture risk.; Results. A cohort of 112, 463 women were identified of which 12.5% were dispensed at least one OSRx between April 1st , 1998 and March 31st, 2002. Factors associated with the likelihood of treatment initiation included: a prior BMD assessment, age, prior osteoporosis-fracture status, income level, and region of residence. Given the strong predictive effect of a BMD assessment on the likelihood of treatment initiation, it was necessary to explore the factors associated with receiving this test. Above all other variables tested, the BMD-testing rate of a woman's physician most strongly predicted her likelihood of receiving a BMD test. (Abstract shortened by UMI.)
机译：介绍。不能从随机临床试验中确定骨质疏松症处方药在预防和治疗骨质疏松症方面的“真实世界”有效性。本文使用行政健康数据库中的数据，提出了一项回顾性观察研究方法，专门测量了在临床试验场外（即在``真实世界''中）接受治疗的妇女的骨质疏松相关性骨折的风险。但是，与接受处方治疗有关的几个因素阻止了直接比较治疗个体与未治疗个体的结果。本文试图确定这些因素，并最终将这些信息应用于整体“药物有效性”模型。方法。使用基于人群的行政健康数据库，确定了一组年龄在50岁以上的女性。分析了1996年至2002年的药物索赔数据，以识别骨质疏松症处方药（OSRx）的新用户。进行了三个单独的Cox比例风险回归分析，以确定与（a）启动OSRx的可能性相关的因素； （b）接受骨矿物质密度（BMD）评估的可能性； （c）中止治疗的可能性。鉴于在这些分析中均已确定的因素，根据妇女启动OSRx的可能性制定了倾向评分以对妇女进行分层，并开发了最终的分层Cox比例风险模型以评估OSRx治疗对骨折风险的总体影响。结果。在1998年4月1日至2002年3月31日期间，共有112 463名妇女被纳入研究，其中至少有一项OSRx分配了12.5％。与开始治疗的可能性有关的因素包括：先前的BMD评估，年龄，先前的骨质疏松症-骨折状况，收入水平和居住地区。鉴于BMD评估对治疗开始的可能性具有很强的预测作用，因此有必要探讨与接受该检查有关的因素。除了测试的所有其他变量之外，女性医生的BMD测试率最能强烈地预测她接受BMD测试的可能性。 （摘要由UMI缩短。）

著录项

  • 作者

    Caetano, Patricia A.;

  • 作者单位

    University of Manitoba (Canada).;

  • 授予单位 University of Manitoba (Canada).;
  • 学科 Health Sciences Pharmacy.; Health Sciences Public Health.
  • 学位 Ph.D.
  • 年度 2005
  • 页码 223 p.
  • 总页数 223
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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