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Tian L, Luo C, Li YF, Wang QY, Qu XL, Yue C, Xu LL, Yang YY, Sheng ZF. Economic evaluation of four treatment strategies for postmenopausal patients with osteoporosis and a recent fracture in mainland China: a cost-effectiveness analysis. Arch Osteoporos 2023; 18:100. [PMID: 37460858 DOI: 10.1007/s11657-023-01309-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
Postmenopausal patients with osteoporosis who have a recent fracture are at very high risk of fracture, and this study finds that stratified treatment based on fracture risk would be a cost-effective treatment option for this population. PURPOSE To evaluate the cost-effectiveness of four anti-osteoporosis medications (denosumab, zoledronate, teriparatide, and alendronate) for postmenopausal osteoporotic women in mainland China, using a stratified treatment strategy recommended by the American Association of Clinical Endocrinologists and the American College of Endocrinology (AACE/ACE). METHODS A microsimulation Markov model was used to compare the cost-effectiveness of the four treatments in postmenopausal osteoporotic patients of different ages (65, 70, 75, and 80 years), with a recent fracture from the Chinese healthcare perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represent the incremental cost per quality-adjusted life-year (QALY) obtained. One-way deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were performed to assess the robustness of model findings. RESULTS Alendronate was dominated by denosumab-to-alendronate and zoledronate at all ages examined, indicating that the costs of the two drugs were lower, but QALYs was greater. However, teriparatide-to-alendronate yielded an ICER of $76,432.07/ QALY, compared with alendronate at age 65, which exceeded the pre-determined willingness-to-pay threshold of $37,653/ QALY. The results were similar at other ages. The DSA showed that the most sensitive parameters were drug efficacy for vertebral and wrist fractures, the relative risk of vertebral fractures, and the persistence of the drugs. The PSA showed that zoledronate had a 100% probability of being the most cost-effective treatment, with a willingness-to-pay threshold of $37,653/ QALY. CONCLUSION Stratified treatment based on very high fracture risk is more cost-effective than conventional pills in mainland China. Among the stratified treatments, zoledronate is the optimal option.
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Affiliation(s)
- Lin Tian
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Chuo Luo
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Yong-Fang Li
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Qin-Yi Wang
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Xiao-Li Qu
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Chun Yue
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Lu-Lu Xu
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yan-Yi Yang
- Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhi-Feng Sheng
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, 410011, China.
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Jiang Y, Jiang S, Li L, Shi S, Li M, Si L. Cost Effectiveness of Denosumab for Secondary Prevention of Osteoporotic Fractures Among Postmenopausal Women in China: An Individual-Level Simulation Analysis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:489-499. [PMID: 36626041 DOI: 10.1007/s40258-022-00784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVE This study evaluated the cost effectiveness of denosumab versus alendronate for secondary prevention of osteoporotic fractures among post-menopausal women in China. METHODS A validated individual-level simulation model of osteoporotic fractures in the Chinese setting was adapted. Allowing both treatment discontinuation and waning effects, the analysis aimed to evaluate the incremental cost-effectiveness ratio of denosumab compared to alendronate by simulating a cohort of previously fractured individuals over the residual lifetime from the healthcare system perspective. Hip, vertebral, and wrist/humeral fractures were tracked along with the associated medical costs and quality-adjusted life-years. Age-related health state utility values, health state utility values of fractures, costs, fracture incidence, and mortality risks for Chinese were used whenever available. Comparative effectiveness data were obtained from a published network meta-analysis. One-way and probabilistic sensitivity analyses were conducted. RESULTS In the base case, denosumab was dominated by alendronate with incremental costs of CN¥2743 (US$425) and incremental health outcomes of - 0.20 quality-adjusted life-years at its current price in mainland China. It remained dominated in all one-way sensitivity analysis robustness checks. However, denosumab was cost effective if both drugs did not carry any waning effects. In the probabilistic sensitivity analysis, denosumab remained dominated in all replications. CONCLUSIONS Denosumab is not cost effective for preventing secondary fractures among overall postmenopausal women in China. It is advisable to identify alternative denosumab regimens for high-risk subgroups among previously fractured postmenopausal women.
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Affiliation(s)
- Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Shan Jiang
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Limin Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Si Shi
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Mincai Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia.
- School of Health Policy & Management, Nanjing Medical University, Nanjing, Jiangsu, China.
- , Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Yu G, Tong S, Liu J, Wan Y, Wan M, Li S, You R. A systematic review of cost‑effectiveness analyses of sequential treatment for osteoporosis. Osteoporos Int 2022; 34:641-658. [PMID: 36527476 DOI: 10.1007/s00198-022-06626-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
Sequential treatment of osteoporosis has been increasingly mentioned in recent years. However, the corresponding systematic review has not been reported. This study aims to systematically review and assess all full-text pharmacoeconomic studies of sequential treatment for osteoporosis. A comprehensive literature search was performed using PubMed, EMBASE (Ovid), CNKI, and Wanfang Database to identify original articles, published before June 17, 2022. The quality of included articles was evaluated by the updated Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases International Osteoporosis Foundation (ESCEO-IOF). In general, ten articles were included in this review. For the comparison between sequential treatment and bisphosphonate monotherapy, more than 75% of studies demonstrated the sequential treatment was cost-effective or dominant, with the exception of sequential treatment involving teriparatide. When the comparisons occurred between the two sequential treatment groups, the sequential treatments associated with either abaloparatide or romosozumab were cost-effective or dominant compared to the sequential treatment involving teriparatide. Several major key drivers of cost-effectiveness included drug cost, medication persistence and adherence, drug effect on fracture risk, offset effect, time horizon, and baseline fracture risk. The most of studies were identified as high quality in CHEERS (2022) and ESCEO-IOF. The cost-effectiveness of sequential treatment for osteoporosis is influenced by multiple factors. Generally, the sequential treatments involving abaloparatide, romosozumab, denosumab, and bisphosphonates may be considered as the preferred option for osteoporosis with high fracture risk, while the sequential treatment with teriparatide was not a cost-effectiveness strategy. The ESCEO-IOF and CHEER (2022) increase the transparency, comparability, extrapolation, and quality of research, engage patients and the general public in research on health services and policies, and help improve the quality of health technology assessment.
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Affiliation(s)
- Guangyi Yu
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, Hubei, China
| | - Suiju Tong
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, Hubei, China
| | - Jinyu Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuansheng Wan
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - Min Wan
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, Hubei, China
| | - Sujuan Li
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, Hubei, China
| | - Ruxu You
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China.
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4
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Chen L, Zhu W, Zhu S, Ding Q. Effects of alendronate combined with local radiotherapy on serum Akt/GSK3β and bone metabolism levels in patients with bone metastases from primary liver cancer. Am J Transl Res 2022; 14:6669-6677. [PMID: 36247307 PMCID: PMC9556457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate the effects of alendronate combined with local radiotherapy on the level of serum Akt/GSK3β and bone metabolism in patients of primary liver cancer with bone metastases. METHODS Clinical data of 68 patients of primary liver cancer with bone metastases and treated in Shanghai General Hospital, a hospital affiliated to Shanghai Jiao Tong University School of Medicine, were retrospectively analyzed. According to the different surgical methods, the patients were divided into a control group, with 33 cases treated with local radiotherapy plus Oxycodone hydrochloride extended-release tablets, and a study group, with 35 cases treated with alendronate combined with local radiotherapy. The remission rate and adverse reaction rate were compared between the two groups. In addition, we observed and compared the liver function indexes (total bilirubin (TBIL), alanine aminotransferase (ALT) and alkaline phosphatase (ALP)), serum Akt/GSK3β level, bone metabolism levels (bone alkaline phosphatase (BAP) and levels of osteocalcin (OST)), α-fetoprotein (AFP), vascular endothelial growth factor (VEGF), osteopontin (OPN), matrix metallopeptidase 9 (MMP-9), and quality of life of the patients in two groups before and after treatment. RESULTS A higher remission rate was observed in the study group (94.29%) than that in the control group (75.76%) (P<0.05). There was no significant difference in the adverse reaction rate between the study group (20.00%) and the control group (12.12%) (P>0.05). In both groups, the post-treatment serum levels of TBIL, ALT, ALP, Akt, GSK3β, AFP, VEGF, OPN, MMP-9, hardship and nausea due to cancer were all decreased, while serum levels of BAP and OST, and psychological, physical and social functions were all increased (all P<0.05). The improvement of the above indicators in the study group were better than those in the control group (all P<0.05). CONCLUSION The use of alendronate combined with local radiotherapy received good response in patients of primary liver cancer with bone metastasis. In addition, their liver function, bone metabolism levels and quality of life all improved without increasing adverse reactions. The underlying mechanism may be related to the regulation of Akt and GSK3β levels.
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Affiliation(s)
- Lin Chen
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of MedicineShanghai 200080, China
| | - Weina Zhu
- Department of Pharmacy, Hwa Mei Hospital, University of Chinese Academy of SciencesNingbo 315000, Zhejiang, China
| | - Shenghao Zhu
- Department of Gastroenterology, Hwa Mei Hospital, University of Chinese Academy of SciencesNingbo 315000, Zhejiang, China
| | - Quanhua Ding
- Department of Gastroenterology, Hwa Mei Hospital, University of Chinese Academy of SciencesNingbo 315000, Zhejiang, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of SciencesNingbo 315000, Zhejiang, China
- Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang ProvinceNingbo 315000, Zhejiang, China
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Hiligsmann M, Li N, Cooper C, Reginster JY, Silverman S, Carswell C, Husereau D. Improving the reporting of economic evaluation in osteoporosis: the value of CHEERS 2022 statement. Osteoporos Int 2022; 33:1641-1642. [PMID: 35414136 DOI: 10.1007/s00198-022-06400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Affiliation(s)
- M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands.
| | - N Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - J-Y Reginster
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - S Silverman
- Cedars-Sinai Medical Center, Los Angeles, USA
| | - C Carswell
- Adis Journals, Springer Nature, Auckland, New Zealand
| | - D Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Institute of Health Economics, Edmonton, AB, Canada
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Wan Y, Zeng F, Tan H, Lu Y, Zhang Y, Zhao L, You R. Cost-effectiveness analyses of denosumab for osteoporosis: a systematic review. Osteoporos Int 2022; 33:979-1015. [PMID: 35059777 DOI: 10.1007/s00198-021-06268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
UNLABELLED This paper systematically reviewed and assessed all retrievable pharmacoeconomic studies on denosumab for the treatment of osteoporosis. Denosumab was more cost-effective in patients with older age, prior fracture experience, lower BMD T-scores, and more risk factors. ESCEO-IOF guidelines were more applicable to improve the quality of pharmacoeconomic studies in osteoporosis. INTRODUCTION There are many pharmacoeconomic studies on denosumab for osteoporosis. However, the corresponding reviews are outdated or incomplete and need to be updated and refined. This article aims to systematically review and evaluate all retrievable pharmacoeconomic studies of denosumab for osteoporosis. METHODS A systematic literature search was performed utilizing PubMed, EMBASE(Ovid), Proquest(EconLit), Chongqing VIP, WanFang Database, and Chinese National Knowledge Infrastructure to identify full-text articles published before September 2021. The quality of full-text articles was evaluated by the Consolidated Health Economic Evaluation Reporting Standards(CHEERS) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases International Osteoporosis Foundation guideline(ESCEO-IOF). RESULTS In total, 21 full-text articles were eligible for inclusion. Denosumab for postmenopausal osteoporosis was not dominant compared to zoledronate and teriparatide. However, denosumab was dominant compared with strontium ranelate, raloxifene, and ibandronate in patients over 65 years. The probabilities of denosumab being cost-effective or dominant were more than 85% compared with no treatment and risedronate in patients aged over 70 years. Compared to alendronate, the highest rate of denosumab dominance occurred in patients aged 65 to 75 years, at about 65%. Most of the articles had higher CHEERS scores than ESCEO-IOF scores (converted into percentages). CONCLUSIONS The cost-effectiveness of denosumab for the treatment of osteoporosis was influenced by multiple factors. Generally, denosumab was more cost-effective in patients with older age, prior fracture experience, lower BMD T-scores, and more risk factors. ESCEO-IOF guidelines were more applicable to improve the transparency, generalization, and quality of pharmacoeconomic studies in osteoporosis.
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Affiliation(s)
- Y Wan
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - F Zeng
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - H Tan
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - Y Lu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - Y Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China
| | - L Zhao
- Department of Pharmacy, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - R You
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China.
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Mori T, Komiyama J, Fujii T, Sanuki M, Kume K, Kato G, Mori Y, Ueshima H, Matsui H, Tamiya N, Sugiyama T. Medical expenditures for fragility hip fracture in Japan: a study using the nationwide health insurance claims database. Arch Osteoporos 2022; 17:61. [PMID: 35403938 PMCID: PMC9001568 DOI: 10.1007/s11657-022-01096-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/09/2022] [Indexed: 02/03/2023]
Abstract
Using the nationwide health insurance claims database in Japan, we estimated total annual medical expenditures for fragility hip fracture across the population at 329.2 billion yen (2.99 billion US dollars). Long-term care expenditures were not included. Fragility hip fracture imposes a considerable health economic burden on society in Japan. PURPOSE Fragility hip fracture imposes a substantial health economic burden on society globally. We aimed to estimate medical expenditures for fragility hip fracture using the nationwide health insurance claims database in Japan. METHODS We included adults aged 60 and over without prior hip fracture who were admitted for fragility hip fracture (i.e., femoral neck or extracapsular) between October 2014 and October 2015 (13 months). Fragility hip fracture was identified through newly assigned disease codes for fracture and procedure codes associated with the fracture. As a proxy for medical expenditures per patient, incremental payments were calculated (i.e., the difference between the total payments 6 months before and after fragility hip fracture). The total payments included health insurance reimbursements and copayments for inpatient and outpatient services. Long-term care expenditures were not included in this study. RESULTS We identified 142,361 individuals (28,868 male and 113,493 female) with fragility hip fracture. Mean medical expenditures for fragility hip fracture per patient were 2,550,000 yen (¥) (23,180 US dollars [$]; ¥110 = $1) in male and ¥2,494,000 ($22,670) in female patients, respectively. Total annual medical expenditures for fragility hip fracture across the population were 329.2 billion yen (2.99 billion US dollars): 67.96 billion yen (620 million US dollars) in male and 261.24 billion yen (2.37 billion US dollars) in female patients, respectively. CONCLUSION This is the first study to estimate medical expenditures for hip fracture using the nationwide health insurance claims database, which represents almost all health insurance claims in Japan. Fragility hip fracture inflicts a considerable health economic burden on society in Japan.
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Affiliation(s)
- Takahiro Mori
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan. .,Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan. .,Department of General Internal Medicine, Eastern Chiba Medical Center, Togane, Chiba, Japan.
| | - Jun Komiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tomoko Fujii
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.,Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaru Sanuki
- Department of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keitaro Kume
- Department of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Genta Kato
- Solutions Center for Health Insurance Claims, Kyoto University Hospital, Kyoto, Japan
| | - Yukiko Mori
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Hiroaki Ueshima
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Nanako Tamiya
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takehiro Sugiyama
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
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Curtis EM, Reginster JY, Al-Daghri N, Biver E, Brandi ML, Cavalier E, Hadji P, Halbout P, Harvey NC, Hiligsmann M, Javaid MK, Kanis JA, Kaufman JM, Lamy O, Matijevic R, Perez AD, Radermecker RP, Rosa MM, Thomas T, Thomasius F, Vlaskovska M, Rizzoli R, Cooper C. Management of patients at very high risk of osteoporotic fractures through sequential treatments. Aging Clin Exp Res 2022; 34:695-714. [PMID: 35332506 PMCID: PMC9076733 DOI: 10.1007/s40520-022-02100-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/11/2022]
Abstract
Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment and a range of effective pharmacological agents. Currently, bone-forming (anabolic) agents, in many countries, are used in those patients who have continued to lose bone mineral density (BMD), patients with multiple subsequent fractures or those who have fractured despite treatment with antiresorptive agents. However, head-to-head data suggest that anabolic agents have greater rapidity and efficacy for fracture risk reduction than do antiresorptive therapies. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) convened an expert working group to discuss the tools available to identify patients at high risk of fracture, review the evidence for the use of anabolic agents as the initial intervention in patients at highest risk of fracture and consider the sequence of therapy following their use. This position paper sets out the findings of the group and the consequent recommendations. The key conclusion is that the current evidence base supports an "anabolic first" approach in patients found to be at very high risk of fracture, followed by maintenance therapy using an antiresorptive agent, and with the subsequent need for antiosteoporosis therapy addressed over a lifetime horizon.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Jean-Yves Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000, Liège, Belgium
| | - Nasser Al-Daghri
- Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia
| | - Emmanuel Biver
- Division of Bone Diseases, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Maria Luisa Brandi
- F.I.R.M.O, Italian Foundation for the Research on Bone Diseases, Florence, Italy
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liege, CHU de Liège, Liège, Belgium
| | - Peyman Hadji
- Center of Bone Health, Frankfurt, Germany
- Philipps-University of Marburg, Marburg, Germany
| | | | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - Olivier Lamy
- University of Lausanne, UNIL, CHUV, Lausanne, Switzerland
| | - Radmila Matijevic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinical Center of Vojvodina, Clinic for Orthopedic Surgery, Novi Sad, Serbia
| | - Adolfo Diez Perez
- Department of Internal Medicine, Hospital del Mar-IMIM, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Madrid, Spain
| | - Régis Pierre Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liege, CHU de Liège, Liège, Belgium
| | | | - Thierry Thomas
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
- INSERM U1059, Université de Lyon, Université Jean Monnet, Saint-Etienne, France
| | | | - Mila Vlaskovska
- Medical Faculty, Department of Pharmacology and Toxicology, Medical University Sofia, Sofia, Bulgaria
| | - René Rizzoli
- Division of Bone Diseases, Department of Medicine, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
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You R, Liu J, Ke L, Wan M, Zhang Y, Yu G, Mori T. Cost-Effectiveness of Sequential Denosumab/Zoledronic Acid Compared With Zoledronic Acid Monotherapy for Postmenopausal Osteoporotic Women in China. Front Pharmacol 2022; 13:816248. [PMID: 35370751 PMCID: PMC8971554 DOI: 10.3389/fphar.2022.816248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: The primary purpose of this study was to estimate the cost-effectiveness of sequential denosumab/zoledronic acid versus zoledronic acid monotherapy for postmenopausal osteoporotic women in China. Methods: We updated and utilized a previously validated Markov microsimulation model to obtain the cost-effectiveness of two strategies for treating postmenopausal osteoporotic women. We compared the incremental cost-effectiveness ratios (ICERs) (US dollars [$] per quality-adjusted life year [QALY]) of sequential denosumab/zoledronic acid (i.e., biannual subcutaneous denosumab for 3 years followed by annual intravenous zoledronic acid for 3 years) with zoledronic acid monotherapy for 3 years in Chinese women with postmenopausal osteoporosis at ages 65, 70, 75, and 80 from the health care payer perspective. Our study’s willingness-to-pay (WTP) threshold was set to three times the value of China’s per capita GDP in 2020 ($31,512). Results: The ICERs of sequential denosumab/zoledronic acid versus zoledronic acid monotherapy were $59,389/QALY, $23,821/QALY, $22,710/QALY, and $14,027/QALY at age 65, 70, 75, and 80 years, respectively. One-way sensitivity analyses showed that the most impactful parameter was the persistence rate of the medications. If the persistence rate of denosumab or zoledronic acid was increased by 10%, sequential denosumab/zoledronic acid would be cost-effective at age 65. In probabilistic sensitivity analyses, the probabilities of sequential denosumab/zoledronic being cost-effective compared to zoledronic acid monotherapy were approximately 29.3%, 68.7%, 86.1%, and 99.4% for ages 65, 70, 75, and 80 years, respectively, at the WTP threshold of $31,512/QALY. Conclusion: Among Chinese postmenopausal osteoporosis women over 70 years old, sequential denosumab/zoledronic acid was cost-effective compared with zoledronic acid monotherapy at the pre-determined WTP threshold.
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Affiliation(s)
- Ruxu You
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinyu Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Ke
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Wan
- Department of Pharmacy, People’s Hospital of Dongxihu District, Wuhan, China
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangyi Yu
- Department of Pharmacy, People’s Hospital of Dongxihu District, Wuhan, China
- *Correspondence: Guangyi Yu, ; Takahiro Mori,
| | - Takahiro Mori
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
- Department of General Internal Medicine, Eastern Chiba Medical Center, Togane, Japan
- *Correspondence: Guangyi Yu, ; Takahiro Mori,
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You R, Liu J, Ke L, Yu G, Zhang Y, Mori T. Cost-Effectiveness of Sequential Teriparatide/Zoledronic Acid Compared With Zoledronic Acid Monotherapy for Postmenopausal Osteoporotic Women in China. Front Public Health 2022; 10:794861. [PMID: 35284380 PMCID: PMC8907523 DOI: 10.3389/fpubh.2022.794861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objective We aimed to assess the cost-effectiveness of sequential teriparatide/zoledronic acid relative to zoledronic acid monotherapy for postmenopausal osteoporotic women in China. Methods A previously validated Markov microsimulation model was updated to examine the cost-effectiveness of daily subcutaneous teriparatide for 2 years followed by annual intravenous zoledronic acid for 3 years (sequential teriparatide/zoledronic acid), compared with zoledronic acid monotherapy for 3 years in Chinese women with postmenopausal osteoporosis at ages 65, 70, 75, and 80 from the health care payer perspective. Results The incremental cost-effectiveness ratios (ICERs) (US dollars [$] per quality-adjusted life-year [QALY]) of sequential teriparatide/zoledronic acid vs. zoledronic acid monotherapy was $173,223/QALY at age 65 years, which was much higher than the pre-determined willingness-to-pay (WTP) threshold of $ 31,512/QALY, and the results were similar at other ages. In one-way sensitivity analyses, the two most impactful parameters were the cost of teriparatide and the residual effects of the medications included in this study. Sequential teriparatide/zoledronic acid became cost-effective at age 80 with the cost of teriparatide reduced by 50%. Without the residual effect, the ICER increased to $257,982/QALY. Probabilistic sensitivity analyses shown that the probabilities of zoledronic acid monotherapy being cost-effective were 100% at a WTP of $31,512/QALY. Conclusions Among Chinese women with postmenopausal osteoporosis, sequential teriparatide/zoledronic acid was not cost-effective unless the cost of teriparatide was reduced by 50% only for the participants over 80 years.
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Affiliation(s)
- Ruxu You
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinyu Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Ke
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangyi Yu
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, China
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Takahiro Mori
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
- Department of General Internal Medicine, Eastern Chiba Medical Center, Togane, Chiba, Japan
- *Correspondence: Takahiro Mori
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Huang XL, Liu C, Shi XM, Cheng YT, Zhou Q, Li JP, Liao J. Zoledronic acid inhibits osteoclastogenesis and bone resorptive function by suppressing RANKL‑mediated NF‑κB and JNK and their downstream signalling pathways. Mol Med Rep 2021; 25:59. [PMID: 34935053 PMCID: PMC8711024 DOI: 10.3892/mmr.2021.12575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/23/2021] [Indexed: 11/06/2022] Open
Abstract
Targeting excessive osteoclast differentiation and activity is considered a valid therapeutic approach for osteoporosis. Zoledronic acid (ZOL) plays a pivotal role in regulating bone mineral density. However, the exact molecular mechanisms responsible for the inhibitory effects of ZOL on receptor activator of nuclear factor (NF)-κB ligand (RANKL)-induced osteoclast formation are not entirely clear. The present study aimed to investigate the role of ZOL in osteoclast differentiation and function, and to determine whether NF-κB and mitogen-activated protein kinase, and their downstream signalling pathways, are involved in this process. RAW264.7 cells were cultured with RANKL for differentiation into osteoclasts, in either the presence or absence of ZOL. Osteoclast formation was observed by tartrate-resistant acid phosphatase staining and bone resorption pit assays using dentine slices. The expression of osteoclast-specific molecules was analysed using reverse transcription-quantitative polymerase chain reaction and western blotting assays to deduce the molecular mechanisms underlying the role of ZOL in osteoclastogenesis. The results showed that ZOL significantly attenuated osteoclastogenesis and bone resorptive capacity in vitro. ZOL also suppressed the activation of NF-κB and the phosphorylation of c-Jun N-terminal kinase. Furthermore, it inhibited the expression of the downstream factors c-Jun, c-Fos and nuclear factor of activated T cells c1, thereby decreasing the expression of dendritic cell-specific transmembrane protein and other osteoclast-specific markers. In conclusion, ZOL may have therapeutic potential for osteoporosis.
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Affiliation(s)
- Xiao-Lin Huang
- Stomatology Medical Center of Zhongshan People's Hospital, Zhongshan, Guangdong 528403, P.R. China
| | - Chao Liu
- Department of Respiratory Disease, Zhongshan People's Hospital, Zhongshan, Guangdong 528403, P.R. China
| | - Xue-Mei Shi
- Stomatology Medical Center of Zhongshan People's Hospital, Zhongshan, Guangdong 528403, P.R. China
| | - Yu-Ting Cheng
- School/Hospital of Stomatology, Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Qian Zhou
- School/Hospital of Stomatology, Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Jian-Ping Li
- Stomatology Medical Center of Zhongshan People's Hospital, Zhongshan, Guangdong 528403, P.R. China
| | - Jian Liao
- School/Hospital of Stomatology, Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
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You R, Mori T, Ke L, Wan Y, Zhang Y, Luo F, Feng D, Yu G, Liu J. Which injected antiosteoporotic medication is worth paying for? A cost-effectiveness analysis of teriparatide, zoledronate, ibandronate, and denosumab for postmenopausal osteoporotic women in China. Menopause 2021; 29:210-218. [PMID: 34930866 DOI: 10.1097/gme.0000000000001911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the cost-effectiveness of four injected antiosteoporotic medications including teriparatide, zoledronate, ibandronate, and denosumab for postmenopausal osteoporotic women in China. METHODS A Markov microsimulation model was used to compare the cost-effectiveness of the four drugs above in Chinese postmenopausal osteoporotic women with no fracture history of hip, vertebral, or wrist at various ages (65, 70, 75, and 80) of therapy initiation from the health care payer perspective. RESULTS Denosumab was dominant (ie, lower costs and greater quality-adjusted life-years [QALYs]) compared with other strategies at all ages studied. The incremental cost-effectiveness ratios (ICERs) of zoledronate or ibandronate versus no treatment were $4,482.88/ QALYs or $11,378/QALYs, respectively, at age 65 years, and the results at other ages were similar. In contrast, the incremental cost-effectiveness ratio of teriparatide strategy compared with no treatment exceeded the pre-determined threshold of a willingness-to-pay of $31,512/QALY regardless of the adoption of the patient assistance program at all ages studied, and a threshold analysis showed that teriparatide without patient assistance program became cost-effective when the annual drug cost is decreased to $1,644.87 (current cost: $8,764.65). The cost-effectiveness decision did not change in most of the one-way sensitivity analyses. A scenario analysis considering no offset effect of denosumab showed that zoledronate had the potential to become the optimal option relative to denosumab. In probabilistic sensitivity analyses, the probabilities of denosumab being cost-effective compared with other strategies were 100% at a willingness-to-pay of $31,512/QALY. CONCLUSIONS Among postmenopausal osteoporotic women in China, denosumab therapy is cost-effective at all ages examined from the health care payer perspective, compared with teriparatide, zoledronate, or ibandronate. This study will help clinicians and policymakers make better decisions about the relative economic value of osteoporosis treatments in China.
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Affiliation(s)
- Ruxu You
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Takahiro Mori
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of General Internal Medicine, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Lei Ke
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuansheng Wan
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fei Luo
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangyi Yu
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, Hubei 430040, China
| | - Jinyu Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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