Frequency of discontinuation of injectable osteoporosis therapies in US patients over 2 years.

Little is known about treatment patterns with injectable osteoporosis therapies. At 12 months, the probability of discontinuation was 69.1% among patients using ibandronate, followed by teriparatide (67.1%), zoledronic acid (59.2%), and denosumab (48.8%). By 24 months, discontinuation was higher for each treatment. The majority of US patients discontinue injectable osteoporosis treatment by the end of the first year following initiation. INTRODUCTION: This study was designed to assess the frequency of treatment discontinuation over time among patients who initiate injectable osteoporosis therapies. METHODS: This retrospective observational study utilized an administrative claims database to measure discontinuation of injectable osteoporosis therapy, reported at 6-month intervals over 2 years. Eligible patients were aged ≥55 years, had newly initiated injectable osteoporosis therapy between January 2008 and June 2012, and were continuously enrolled in the health plan for ≥1 year prior to and ≥1.5 years after the date the first injectable medication was received (the index date). Follow-up time ranged from 18 to 24 months. Injectable osteoporosis treatments included in the analysis were denosumab, ibandronate, teriparatide, and zoledronic acid. Discontinuation was assessed using Kaplan-Meier survival analysis and was defined at each time point as the percentage of patients who did not receive the dose scheduled for that time point. A 90-day grace period was allowed to accommodate flexibility in the scheduling of post-index re-administrations. Sensitivity analyses assessed discontinuation using grace periods of 60 and 30 days. RESULTS: A total of 4756 patients met the inclusion criteria for the study, with 617 utilizing denosumab, 233 ibandronate, 778 teriparatide, and 3128 zoledronic acid. At 12 months, discontinuation was highest among patients using ibandronate (69.1%), followed by teriparatide (67.1%), zoledronic acid (59.2%), and denosumab (48.8%). By 24 months, discontinuation was higher for each treatment: 87.5% for ibandronate, 87.9% for teriparatide, 79.8% for zoledronic acid, and 64.3% for denosumab. CONCLUSIONS: The majority of US patients discontinue injectable osteoporosis treatment by the end of the first year following initiation.

The epidemiological and economic impact of a quadrivalent human papillomavirus vaccine (6/11/16/18) in the UK.

OBJECTIVE: To assess the potential epidemiological and economic impact of a prophylactic quadrivalent human papillomavirus (HPV) (6/11/16/18) vaccine for preventing cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN2/3), CIN1 and genital warts. DESIGN: Cost-utility analysis. SETTING: UK. POPULATION: Female and male UK population 12 years or older. METHODS: We adapted a previously developed multi-HPV type dynamic transmission to compare four female vaccination strategies, routine vaccination at age 12 years, and routine vaccination at age 12 years combined with temporary catch-up vaccination at ages 12-14, 12-17 and 12-24 years. MAIN OUTCOMES MEASURES: Costs, cases avoided, incremental cost per quality-adjusted life year (QALY). RESULTS: The model projected that at year 100, each vaccination strategy could reduce the number of HPV 6/11/16/18-related cervical cancer, CIN2/3, CIN1 and genital wart cases among women by 86, 85, 79 and 89% respectively. Over 25 years, routine vaccination at age 12 years combined with a 12- to 24-year-old catch-up programme was the most effective strategy, reducing the cumulative number of cases of cervical cancer, CIN2/3, CIN1 and genital warts by 5800, 146 000, 28 000, and 1.1 million respectively. Over 100 years, the incremental cost-effectiveness ratios across all strategies ranged from pound5882 to pound11,412 per QALY gained. CONCLUSION: In the UK, a quadrivalent HPV vaccination programme that includes a catch-up strategy can reduce the incidence of cervical cancer, CIN and genital warts at a cost per QALY ratio within the range typically regarded as cost-effective.

Trends in malignant melanoma incidence and mortality in Wisconsin, 1979-1997.

OBJECTIVE: To explore trends in malignant melanoma incidence and mortality in Wisconsin from 1979 to 1997, by age, gender and time period. Comparisons are also made to US trends over this period. DATA: Incidence data for Wisconsin were provided by the Wisconsin Cancer Reporting System Bureau of Health Information, within the Wisconsin Department of Health and Family Services, while US data were extracted using SEER*Stat 3.0. Mortality data for both Wisconsin and the US were compiled using CDC WONDER. RESULTS: Wisconsin malignant melanoma incidence rates rose 25% from 1979 to 1998, compared to a US increase of 132%. For mortality rates, however, both Wisconsin (22%) and the US (15%) exhibited only modest increases. Between the mid-1980s and mid-1990s, the largest increases in both incidence and mortality (over 70%) occurred among males over age 65. In contrast, declines of 30% to 40% were found for males age 0-34. Patterns were less consistent among females. CONCLUSIONS: Since the mid-1980s, malignant melanoma incidence in Wisconsin appears to have increased sharply among males and females over age 65, with a corresponding rise in mortality among males in this age group. These trends should be a source of concern for clinicians and policy makers alike. Because current evidence on the effectiveness of early treatment is inconclusive, it is especially important to take preventive measures now--such as educational and community-based interventions--to reduce future incidence.

Trends in homicide in Wisconsin, 1985-1998.

OBJECTIVE: To explore homicide trends for Wisconsin over the period 1985-1998 and assess the state's progress towards meeting its year 2000 health objectives. METHODS: Wisconsin and US homicide data from the Centers for Disease Control's Web-based Injury Statistics Query and Reporting System (WISQARS) were analyzed for the period 1985-1998. RESULTS: Homicide rates in Wisconsin rose 54% between 1985 and 1995, but since that year, a sharp reverse in trends since has erased three-fourths of the increase. While Wisconsin rates for 1998 remain 15% above their 1985 levels, US rates peaked in 1991 and have since fallen to 12% below their 1985 levels. When compared to 1985, Wisconsin homicide rates for 1998 were 24% lower among whites, but 16% higher among blacks. CONCLUSIONS: Wisconsin failed to achieve its year 2000 objective for homicide reductions, with rates remaining over 80% above the state goal. Though Wisconsin's current homicide rate is nearly half the US average, recent reductions in Wisconsin homicide have lagged behind those observed nationally.