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Luo C, Qin SX, Wang QY, Li YF, Qu XL, Yue C, Hu L, Sheng ZF, Wang XB, Wan XM. Cost-effectiveness analysis of five drugs for treating postmenopausal women in the United States with osteoporosis and a very high fracture risk. J Endocrinol Invest 2023; 46:367-379. [PMID: 36044169 PMCID: PMC9428883 DOI: 10.1007/s40618-022-01910-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/20/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Five strategies were recommended by the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) guidelines for the treatment of postmenopausal osteoporosis (PMO) patients with a very high fracture risk. We aimed to assess their cost-effectiveness in the United States (US). METHODS A microsimulation Markov model was created to compare the cost-effectiveness of five treatment strategies, including zoledronate, denosumab, abaloparatide, teriparatide, and romosozumab in PMO patients with a recent fracture from the healthcare perspective of the US. The data used in the model were obtained from published studies or online resources. Base-case analysis, one-way deterministic sensitivity analysis (DSA) and probability sensitivity analysis (PSA) were conducted for 65-, 70-, 75-, and 80-year-old patients. RESULTS In base case, at 65 years, zoledronate was the cheapest strategy. The incremental cost-effectiveness ratios (ICER, which represent incremental costs per QALY gained) of denosumab, teriparatide, abaloparatide, and romosozumab against zoledronate were $13,020/QALY (quality-adjusted years), $477,331 /QALY, $176,287/QALY, and $98,953/QALY, respectively. Under a willing-to-pay (WTP, which means the highest price a consumer will pay for one unit of a good of service) threshold of $150,000/QALY, denosumab and romosozumab were cost-effective against zoledronate. The PSA results showed that denosumab was the most cost-effective option with WTP thresholds of $50,000/QALY, $100,000/QALY and $150,000/QALY. The results were similar in other age groups. The DSA results indicated that the most common parameters that have important influence on the outcome were drug persistence, incidence of adverse events, the efficacy of drugs on hip fractures and the cost of the drug. CONCLUSION AND RELEVANCE Among PMO patients with a very high fracture risk in the US, zoledronate is the cheapest strategy and denosumab is the most cost-effective choice among these five strategies.
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Affiliation(s)
- C Luo
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - S-X Qin
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - Q-Y Wang
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - Y-F Li
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - X-L Qu
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - C Yue
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - L Hu
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China
| | - Z-F Sheng
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China.
| | - X-B Wang
- Divisions of Endocrinology, Metabolism, and Nutrition, Departments of Medicine and Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - X-M Wan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China.
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Viola V, Leanza G, Tramontana F. Letter to the Editor From Viola et al: "Calcifediol Treatment and COVID-19-related Outcomes". J Clin Endocrinol Metab 2021; 106:e5271-e5272. [PMID: 34383045 DOI: 10.1210/clinem/dgab565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Indexed: 01/07/2023]
Affiliation(s)
- Viola Viola
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Giulia Leanza
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Flavia Tramontana
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy
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Kong SH, Hwang BK, Yoon BH. The Impact of COVID-19 on the Optimal Management of Osteoporosis. J Bone Metab 2021; 28:115-122. [PMID: 34130363 PMCID: PMC8206610 DOI: 10.11005/jbm.2021.28.2.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/20/2021] [Indexed: 12/20/2022] Open
Abstract
Osteoporosis does not take a break while Coronavirus disease 2019 (COVID-19) stunned and overtook everyone’s lives. Medical resources were immediately shifted, self-isolation and telemedicine were expanded, ambulatory care services such as bone densitometry and osteoporosis-centered clinics came to a near halt. Progress with fracture prevention has been challenged because osteoporotic fracture with low energy injury is more prevalent even though restriction of people’s movement. Thus we must re-engage with chronic bone health concerns and fracture prevention. This review discusses challenges in management of osteoporosis during the COVID-19 pandemic and reinforces the need to implementing recommendations concerning the importance of bone fragility care with at least those patients who are already treated with antiosteoporotic drugs maintaining their adherence to treatments.
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Affiliation(s)
- Sung Hye Kong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Kwon Hwang
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Mokdong Hospital, Seoul, Korea
| | - Byung-Ho Yoon
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Mokdong Hospital, Seoul, Korea
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