Patient willingness to take teriparatide

Abstract

Objective: Teriparatide [rhPTH (1-34)] is an effective treatment for osteoporosis administered by daily subcutaneous injection. The objective of this study was to determine how much benefit women expect teriparatide to confer before agreeing to perform daily injections.

Methods: We recruited postmenopausal women who had recently undergone bone densitometry and were found to have either a T-score less than -2.5 at the hip or spine and/or had a fracture index (FI) of > or =6. Participants completed an adaptive conjoint analysis questionnaire to determine their treatment preferences.

Results: The study sample included 185 women, mean age 71 (range 46-90). An increasing number of subjects preferred rhPTH (1-34) as the efficacy of teriparatide increased, but most women demanded efficacy advantages greater than those demonstrated in clinical studies. We found no association between absolute fracture risk and preference for rhPTH (1-34); however, subjects with an excessively high perceived risk of future fracture were more likely to accept daily subcutaneous injections compared to subjects with a lower perceived risk of future fracture (40% versus 15%, p = 0.001).

Conclusion: Our results suggest that most women demand benefits far greater than those conferred by rhPTH (1-34) in order to administer daily subcutaneous injections to decrease their future risk of fractures.

Practice implications: Given the poor adherence for treatment of osteoporosis, and the choices older adults must make when paying for medications, development of novel treatment approaches should be based on older adults' treatment preferences.

Figure 1

Percent of Women Preferring rhPTH (1-34) over Bisphosphonates as Benefit of rhPTH (1-34) is Increased Legend: Yellow Line: High Fracture Risk (Fracture Index Score = > 7) Blue Line: Low Fracture Risk (Fracture Index = 6 or 7)

Figure 2

Percent of Women Preferring rhPTH (1-34) over Bisphosphonates as Adverse Effects Associated with Bisphosphonates are Increased Legend: Yellow Line: High Fracture Risk (Fracture Index = > 7) assuming rhPTH (1-34) is associated with a 65% reduction in risk of fractures. Blue Line: Low Fracture Risk (Fracture Index = 6 or 7) assuming rhPTH (1-34) is associatedwith a 65% reduction in risk of fractures. Green Line: High Fracture Risk (Fracture Index = > 7) assuming rhPTH (1-34) is associated with a 75% reduction in risk of fractures. Pink Line: Low Fracture Risk (Fracture Index = 6 or 7) assuming rhPTH (1-34) is associated with a 75% reduction in risk of fractures.