1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
Nayak S, Greenspan SL. Cost-effectiveness of five versus ten years of alendronate treatment prior to drug holiday for women with osteoporosis. Osteoporos Int 2020; 31:1273-1282. [PMID: 32020265 PMCID: PMC8215100 DOI: 10.1007/s00198-019-05258-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022]
Abstract
UNLABELLED We performed a cost-effectiveness analysis comparing 5 versus 10 years of alendronate treatment prior to 5-year drug holiday for US postmenopausal women with hip BMD T-scores between - 2.5 and - 3.5. We found that for most postmenopausal women 5 years of treatment prior to drug holiday is the more effective and cost-effective option. INTRODUCTION We performed a cost-effectiveness analysis to compare 5 versus 10 years of alendronate treatment prior to 5-year drug holiday for postmenopausal osteoporotic women. METHODS We created an individual-level state-transition microsimulation model to compare 3 treatment strategies for US postmenopausal women with osteoporosis and femoral neck BMD T-scores between - 2.5 and - 3.5 at baseline: recurrent periods of 5 years of alendronate followed by 5 years of drug holiday (alendronate 5/5), recurrent periods of 10 years of alendronate followed by 5 years of drug holiday (alendronate 10/5), and no alendronate treatment. RESULTS Base-case analysis revealed for women initiating treatment at ages 50, 60, and 70, the alendronate 5/5 strategy dominated (was more effective and less costly than) the alendronate 10/5 strategy and no treatment. For women age 80, the alendronate 10/5 strategy dominated. When assuming a lower relative risk of nonvertebral fracture during years 6-10 of alendronate treatment than the base-case assumption, the alendronate 10/5 strategy became the most cost-effective strategy even at younger treatment initiation ages. Probabilistic sensitivity analysis results supported the base-case findings; for treatment initiation ages of 50, 60, and 70, the alendronate 5/5 strategy was favored, whereas for treatment initiation age of 80, the alendronate 10/5 strategy was favored; however, there was uncertainty in these findings. CONCLUSIONS After 5 years of alendronate treatment, younger postmenopausal women (ages 50-70) with osteoporosis would likely benefit from a drug holiday, whereas older women (age 80) are likely to benefit from treatment for 10 years before a drug holiday.
Collapse
Affiliation(s)
- S Nayak
- Berkeley Madonna, Inc., Berkeley, CA, USA.
| | - S L Greenspan
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
3
|
Abstract
Aims: This study assessed the cost-effectiveness of denosumab for treating postmenopausal women with osteoporosis (PMO) at high risk of fracture in Thailand.Materials and methods: A published Markov cohort cost-effectiveness model was populated with country-specific data as available and other published data as needed. The model used a societal perspective, lifetime horizon, efficacy data from network meta-analysis of trials, and included costs for direct medical and non-medical care, informal care, and osteoporosis treatments to compare denosumab to no pharmacologic treatment (calcium and vitamin D supplements only) and to oral weekly alendronate. The base case (high-risk population) included postmenopausal women with femoral neck T-score ≤-2.5, mean age 65 years at entry, and history of vertebral fracture.Results: High-risk women with osteoporosis using denosumab had the greatest number of life years and quality-adjusted life-years (QALYs) with higher reductions in hip and vertebral fracture incidence compared with patients with no pharmacologic treatment. The incremental cost-effectiveness ratio (ICER) was 119,575 Thai Baht (THB) per QALY for denosumab versus no pharmacologic treatment and 199,186 THB per QALY for denosumab versus alendronate. Among Thai postmenopausal women with high-risk of fractures, denosumab was cost-effective compared with no pharmacologic treatment at a willingness-to-pay threshold of 160,000 THB per QALY. One-way sensitivity analysis showed models were most sensitive to changes in denosumab pricing.Limitations: Data from other countries used when country-specific data were unavailable may not accurately reflect the true experience in Thailand. The model focused explicitly on hip, vertebral, and wrist fractures, and therefore provides a conservative estimate of the overall potential impact of osteoporosis-related fracture. The fracture risk was not adjusted to reflect potential changes in risk after denosumab treatment discontinuation.Conclusions: In Thailand, denosumab offers a cost-effective osteoporosis treatment option versus no pharmacologic treatment in postmenopausal women at high risk of fracture.
Collapse
Affiliation(s)
| | | | | | - Aasis Unnanuntana
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| |
Collapse
|
4
|
Cui L, He T, Jiang Y, Li M, Wang O, Jiajue R, Chi Y, Xu Q, Xing X, Xia W. Predicting the intervention threshold for initiating osteoporosis treatment among postmenopausal women in China: a cost-effectiveness analysis based on real-world data. Osteoporos Int 2020; 31:307-316. [PMID: 31754756 PMCID: PMC7010623 DOI: 10.1007/s00198-019-05173-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/18/2019] [Indexed: 01/21/2023]
Abstract
UNLABELLED This study built a micro-simulation Markov model to determine the treatment threshold of osteoporosis in postmenopausal women in Mainland China. Treatment with zoledronate is cost-effective when FRAX-based (Fracture risk assessment tool) fracture probability is over 7%. INTRODUCTION The purpose of this study is to estimate FRAX-based fracture probabilities in Mainland China using real-world data, at which intervention could be cost-effective. METHODS We developed a micro-simulation Markov model to capture osteoporosis states and relevant morbidities including hip fracture, vertebral fracture, and wrist fracture. Baseline characteristics including incidences of osteoporosis and distribution of risk factors were derived from the Peking Vertebral Fracture study, the largest prospective cohort study of postmenopausal women in Mainland China. We projected incidences of fractures and deaths by age groups under two treatment scenarios: 1) no treatment, and 2) zoledronate. We also projected total quality-adjusted life-years (QALY) and total costs including fracture management and osteoporosis drugs for cost-effectiveness analysis. Cost-effective intervention thresholds were calculated based on the Chinese FRAX model. RESULTS Treatment with zoledronate was cost-effective when the 10-year probability of major osteoporotic fracture based on FRAX was above 7%. The FRAX threshold increased by age from 51 to 65 years old, and decreased in elder age groups, ranging from 4% to 9%. CONCLUSIONS Using real-world data, our model indicated that widespread use of zoledronate was of both clinical and economic benefit among Chinese postmenopausal women. Using a FRAX-based intervention threshold of 7% with zoledronate should permit cost-effective access to therapy to patients and contribute to reducing the disease burden of osteoporosis in Mainland China.
Collapse
Affiliation(s)
- L Cui
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - T He
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Y Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - M Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - O Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - R Jiajue
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Y Chi
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Q Xu
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - X Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - W Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| |
Collapse
|
5
|
Stopeck A, Brufsky A, Kennedy L, Bhatta S, Bhowmik D, Buchanan J, Despiegel N, Hechmati G. Cost-effectiveness of denosumab for the prevention of skeletal-related events in patients with solid tumors and bone metastases in the United States. J Med Econ 2020; 23:37-47. [PMID: 31364885 DOI: 10.1080/13696998.2019.1651122] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims: Bone complications (also known as skeletal-related events [SREs]) pose significant health and financial burdens on patients with bone metastases. Denosumab demonstrated superiority over zoledronic acid in delaying the time to first SRE. This study examined the lifetime cost-effectiveness of denosumab vs zoledronic acid from both US payer and societal perspectives.Methods: This analysis used a lifetime Markov model and included patients with breast cancer, prostate cancer, and other solid tumors and bone metastases. The societal perspective included direct medical, direct non-medical, and indirect costs associated with denosumab and zoledronic acid; the payer perspective included direct medical costs only. Bone complication rates for each tumor type were estimated from three pivotal phase 3 studies and modified to reflect real-world incidence.Results: From a societal perspective, compared with zoledronic acid, denosumab use resulted in an incremental cost of $9,043, an incremental benefit of 0.128 quality-adjusted life-years (QALYs), a lifetime cost per QALY of $70,730, and a net monetary benefit (NMB) of $10,135 in favor of denosumab. Direct drug costs for denosumab ($28,352) were higher than zoledronic acid/untreated ($578), but were offset by reduced costs associated with bone complications. From a payer perspective, denosumab use was associated with an incremental cost of $13,396, and an incremental benefit of 0.128 QALYs, for a cost of $104,778 per QALY and an NMB of $5,782 in favor of denosumab.Limitations: Some model inputs had limited information and, given that the results may be sensitive to changes in these inputs, our findings should be interpreted within the context of the data inputs and modeling assumptions used in the analysis.Conclusions: Denosumab is a cost-effective option to prevent bone complications in patients with solid tumors when considering both payer and broader societal perspectives.
Collapse
Affiliation(s)
- Alison Stopeck
- Division of Hematology/Oncology, Stony Brook Cancer Center, Stony Brook, NY, USA
| | - Adam Brufsky
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Sumi Bhatta
- Global Health Economics, Amgen Inc, Thousand Oaks, CA, USA
| | | | | | | | - Guy Hechmati
- Global Health Economics, Amgen Inc, Thousand Oaks, CA, USA
| |
Collapse
|
6
|
Svedbom A, Hadji P, Hernlund E, Thoren R, McCloskey E, Stad R, Stollenwerk B. Cost-effectiveness of pharmacological fracture prevention for osteoporosis as prescribed in clinical practice in France, Germany, Italy, Spain, and the United Kingdom. Osteoporos Int 2019; 30:1745-1754. [PMID: 31270592 DOI: 10.1007/s00198-019-05064-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/18/2019] [Indexed: 12/25/2022]
Abstract
UNLABELLED This study estimated the cost-effectiveness of pharmacological fracture prevention as prescribed in the five largest European countries (EU5) using the IOF reference cost-effectiveness model. Pharmacological fracture prevention as prescribed in clinical practice was cost-saving (provided more QALYs at lower costs) compared to no treatment in each of the EU5. PURPOSE To estimate the real-world cost-effectiveness of pharmacological fracture prevention as prescribed in the five largest European countries by population size: France, Germany, Italy, Spain, and the United Kingdom (UK) (collectively EU5). MATERIALS AND METHODS We analyzed sales data on osteoporosis drugs in each of the EU5 to derive a hypothetical intervention that corresponds to the mix of osteoporosis medication prescribed in clinical practice. The costs for this treatment mix were obtained directly from the sales data, and the efficacy of the treatment mix was estimated by weighing the treatment-specific fracture risk reductions from a published meta-analysis. Subsequently, we estimated the cost-effectiveness using costs per quality adjusted life year (QALY) of the intervention compared to no treatment in each of the EU5 using the International Osteoporosis Foundation (IOF) reference cost-effectiveness model. The model population comprised postmenopausal women, mean age 72 years with established osteoporosis (T-score ≤ - 2.5) among whom 23.6% had a prevalent vertebral fracture. The model was populated with country-specific data from the literature. RESULTS Pharmacological fracture prevention as prescribed in clinical practice was cost-saving (provided more QALYs at lower costs) compared to no treatment in each country. The findings were robust in scenario analyses. CONCLUSIONS Pharmacological fracture prevention as prescribed in clinical practice is cost-saving in each of the EU5. Because of the under-diagnosis and under-treatment of post-menopausal osteoporosis, from a health economic perspective, further cost-savings may be reached by expanding treatment to those at increased risk of fracture currently not receiving any treatment.
Collapse
Affiliation(s)
| | - P Hadji
- Frankfurt Center of Bone Disease, Frankfurt/Main, Germany
- Philips-University of Marburg, Marburg, Germany
| | | | | | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - R Stad
- Amgen Europe (GmbH), Suurstoffi 22, P. O. Box 94, CH-6343, Rotkreuz, Switzerland
| | - B Stollenwerk
- Amgen Europe (GmbH), Suurstoffi 22, P. O. Box 94, CH-6343, Rotkreuz, Switzerland.
| |
Collapse
|
7
|
Terpos E, Jamotte A, Christodoulopoulou A, Campioni M, Bhowmik D, Kennedy L, Willenbacher W. A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in four European countries: Austria, Belgium, Greece, and Italy. J Med Econ 2019; 22:766-776. [PMID: 30969797 DOI: 10.1080/13696998.2019.1606002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: The approved indication for denosumab (120 mg) was expanded in 2018 to include skeletal-related event (SRE) prevention in patients with multiple myeloma (MM). Therefore, a cost-effectiveness analysis was conducted comparing denosumab with zoledronic acid (ZA) for SRE prevention in patients with MM from the national healthcare system perspective in a representative sample of European countries: Austria, Belgium, Greece, and Italy. Methods: The XGEVA global economic model for patients with MM was used to calculate incremental cost-effectiveness ratios (ICERs) for denosumab vs ZA over a lifetime horizon. Clinical inputs were derived from the denosumab vs ZA randomized, phase 3 study ("20090482") in patients newly-diagnosed with MM, and comprised real-world adjusted SRE rates, serious adverse event (SAE) rates, treatment duration, dose intensity, progression-free survival (PFS), and overall survival (OS). Economic inputs comprised country-specific denosumab and ZA acquisition and administration costs, SRE and SAE management costs, and discount rates. Health utility decrements associated with MM disease progression, SRE and SAE occurrence, and route of administration were included. Results: Estimated ICERs (cost per quality-adjusted life-year [QALY] gained) for denosumab vs ZA in Austria, Belgium, Greece, and Italy were €26,294, €17,737, €6,982, and €27,228, respectively. Using 1-3 times gross domestic product (GDP) per capita per QALY as willingness to pay thresholds, denosumab was 69-94%, 84-96%, 79-96%, and 50-92% likely to be cost-effective vs ZA, respectively. Limitations: Economic inputs were derived from various sources, and time to event inputs were extrapolated from 20090482 study data. Conclusions: Denosumab is cost-effective vs ZA for SRE prevention in patients with MM in Austria, Belgium, Greece, and Italy, based on often-adopted World Health Organization thresholds. This conclusion is robust to changes in model parameters and assumptions. Cost-effectiveness estimates varied across the four countries, reflecting differences in healthcare costs and national economic evaluation guidelines.
Collapse
Affiliation(s)
- Evangelos Terpos
- a Department of Clinical Therapeutics, School of Medicine , National and Kapodistrian University of Athens , Athens , Greece
| | - Aurelien Jamotte
- b Global Health Economics , Amgen (Europe) GmbH , Rotkreuz , Switzerland
| | | | - Marco Campioni
- b Global Health Economics , Amgen (Europe) GmbH , Rotkreuz , Switzerland
| | | | | | - Wolfgang Willenbacher
- e Department of Internal Medicine V , Innsbruck University Hospital & Oncotyrol, Center for Personalized Cancer Medicine , Innsbruck , Austria
| |
Collapse
|
8
|
Affiliation(s)
- Sarah D. Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Douglas P. Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | |
Collapse
|
9
|
Matuoka JY, Kahn JG, Secoli SR. Denosumab versus bisphosphonates for the treatment of bone metastases from solid tumors: a systematic review. Eur J Health Econ 2019; 20:487-499. [PMID: 30382484 DOI: 10.1007/s10198-018-1011-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/23/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Bone metastases are highly prevalent in breast, prostate, lung and colon cancers. Their symptoms negatively affect quality of life and functionality and optimal management can mitigate these problems. There are two different targeted agents to treat them: bisphosphonates (pamidronate and zoledronic acid) and the monoclonal antibody denosumab. Estimates of cost-effectiveness are still mixed. OBJECTIVE To conduct a systematic review of economic studies that compares these two options. METHOD Literature search comprised eight databases and keywords for bone metastases, bisphosphonates, denosumab, and economic studies were used. Data were extracted regarding their methodologic characteristics and cost-effectiveness analyses. All studies were evaluated regarding to its methodological quality. RESULTS A total of 263 unique studies were retrieved and six met inclusion criteria. All studies were based on clinical trials and other existing literature data, and they had high methodological quality. Most found unfavorable cost-effectiveness for denosumab compared with zoledronic acid, with adjusted ICERS that ranged from $4638-87,354 per SRE avoided and from US$57,274-4.81 M. per QALY gained, which varied widely according to type of tumor, time horizon, among others. Results were sensitive to drug costs, time to first skeletal-related event (SRE), time horizon, and utility. CONCLUSIONS Denosumab had unfavorable cost-effectiveness compared with zoledronic acid in most of the included studies. New economic studies based on real-world data and longer time horizons comparing these therapeutic options are needed.
Collapse
Affiliation(s)
- Jessica Y Matuoka
- School of Nursing of the University of Sao Paulo, 419, Eneas de Carvalho Aguiar Avenue, Sao Paulo, 05403-000, Brazil.
- Hospital Universitario of the University of Sao Paulo, Sao Paulo, Brazil.
| | - James G Kahn
- University of California San Francisco, San Francisco, United States
| | - Silvia R Secoli
- School of Nursing of the University of Sao Paulo, 419, Eneas de Carvalho Aguiar Avenue, Sao Paulo, 05403-000, Brazil
| |
Collapse
|
10
|
Abstract
BACKGROUND There are a lack of guideline recommendations for patients with metastatic castration-resistant prostate cancer (mCRPC) undergoing treatment progression and sequencing. Understanding treatment patterns and associated utilization and costs may help inform stakeholders and guide decision making. OBJECTIVE To describe treatment patterns and health care costs in prostate cancer (PC) patients with bone metastases treated with agents approved by the FDA for mCRPC. METHODS 2 large integrated claims databases (MarketScan and PharMetrics) were used to identify males aged ≥ 18 years who were diagnosed and treated for PC (ICD-9-CM code 185.xx or 233.4) with bone metastases (ICD-9-CM code 198.5) from June 2013 to September 2014. Patients were required to be continuously enrolled for ≥ 6 months before and after initiation of treatment with abiraterone, cabazitaxel, docetaxel, enzalutamide, mitoxantrone, radium-223, sipuleucel-T, or other chemotherapy. Study endpoints included lines of therapy, health care resource utilization per patient per month (PPPM), PPPM costs, and mortality rate. Descriptive analysis was completed for the study sample, and survival function was calculated via Kaplan-Meier estimates. RESULTS There were 953 patients meeting all inclusion criteria in the MarketScan database and 565 patients in the PharMetrics database. The median follow-up time was 18 months (interquartile range [IQR] = 14-23) for MarketScan and 14 months (IQR = 11-18) for PharMetrics. Mean age (SD) was 71 (± 10.7) and 66 (± 9.3) years, respectively. Before mCRPC treatment initiation, patients received palliative radiation therapy and bone antiresorptive therapy. For MarketScan and PharMetrics, respectively, 14.0% and 18.2% of patients received radiation therapy, 36.1% and 40.0% received denosumab; 16.5% and 16.8% received zoledronic acid; and 0.2% and 0.8% received pamidronate. Across both databases, abiraterone was the most commonly received bone metastasis treatment agent across all lines of therapy, except fourth line. Radium-223, cabazitaxel, and mitoxantrone were the least utilized therapies. The median cost PPPM during the post-index period was $10,916 (IQR=$5,334-$13,457) in MarketScan and $10,292 (IQR = $7,245-$14,699) in PharMetrics. The cost PPPM during the 6-month pre-index period was $2,643 (IQR = $850-$4,357) in MarketScan and $2,742 (IQR = $1,484-$4,730) in PharMetrics. CONCLUSIONS Patients were treated mainly with abiraterone across most lines of care, with radium-223, cabazitaxel, and mitoxantrone as the least utilized therapies. Median costs PPPM increased by approximately $8,900 after initiation of FDA-approved agents for mCRPC, with the largest increase in cost stemming from oral medications. DISCLOSURES Funding for this study was provided by Bayer HealthCare Pharmaceuticals. All authors were employees at Bayer HealthCare Pharmaceuticals at the time this study was conducted. This study was presented as a poster at the 2017 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium; February 16-18, 2017; Orlando, FL.
Collapse
Affiliation(s)
- Lonnie Wen
- 1 Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | - Jianying Yao
- 1 Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | | |
Collapse
|
11
|
Hiligsmann M, Reginster JY. Cost-effectiveness of gastro-resistant risedronate tablets for the treatment of postmenopausal women with osteoporosis in France. Osteoporos Int 2019; 30:649-658. [PMID: 30701342 PMCID: PMC6423313 DOI: 10.1007/s00198-018-04821-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/18/2018] [Indexed: 12/21/2022]
Abstract
UNLABELLED The use of gastro-resistant risedronate, a convenient dosing regimen for oral bisphosphonate therapy, seems a cost-effective strategy compared with weekly alendronate, generic risedronate, and no treatment for the treatment of postmenopausal women with osteoporosis in France. INTRODUCTION Gastro-resistant (GR) risedronate tablets are associated with improved persistence compared to common oral bisphosphonates but are slightly more expensive. This study assessed its cost-effectiveness compared to weekly alendronate and generic risedronate for the treatment of postmenopausal women with osteoporosis in France. METHODS A previously validated Markov microsimulation model was used to estimate the lifetime costs (expressed in €2017) per quality-adjusted life-years (QALY) of GR risedronate compared with weekly alendronate, generic risedronate, and no treatment. Pooled efficacy data for bisphosphonates derived from a previous meta-analysis were used for all treatment options, and persistence data (up to 3 years) were obtained from a large Australian longitudinal study. Evaluation was done for high-risk women 60-80 years of age, with a bone mineral density (BMD) T-score ≤ - 2.5 and/or prevalent vertebral fractures. RESULTS In all of the simulated populations, GR risedronate was cost-effective compared to alendronate, generic risedronate, and no treatment at a threshold of €60,000 per QALY gained. In women with a BMD T-score ≤ - 2.5 and prevalent vertebral fractures, the cost per QALY gained of GR risedronate compared to alendronate, generic risedronate, and no treatment falls below €20,000 per QALY gained. In women aged 75 years and older, GR risedronate was even shown to be dominant (more QALYs, less costs) compared to alendronate, generic risedronate, and no treatment. CONCLUSION This study provides the first economic results about GR risedronate, suggesting that it represents a cost-effective strategy compared with weekly alendronate and generic risedronate for the treatment of postmenopausal women with osteoporosis in France.
Collapse
Affiliation(s)
- M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
12
|
Simmons BF, Caprio AJ. Abaloparatide (Tymlos) for Osteoporosis. Am Fam Physician 2019; 99:260-261. [PMID: 30763045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
13
|
Le QA, Hay JW, Becker R, Wang Y. Cost-effectiveness Analysis of Sequential Treatment of Abaloparatide Followed by Alendronate Versus Teriparatide Followed by Alendronate in Postmenopausal Women With Osteoporosis in the United States. Ann Pharmacother 2019; 53:134-143. [PMID: 30160186 PMCID: PMC6311620 DOI: 10.1177/1060028018798034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The US Food and Drug Administration has recently approved abaloparatide (ABL) for treatment of women with postmenopausal osteoporosis (PMO) at high risk of fracture. With increasing health care spending and drug prices, it is important to quantify the value of newly available treatment options for PMO. OBJECTIVE To determine cost-effectiveness of ABL compared with teriparatide (TPTD) for treatment of women with PMO in the United States. METHODS A discrete-event simulation (DES) model was developed to assess cost-effectiveness of ABL from the US health care perspective. The model included three 18-month treatment strategies with either placebo (PBO), TPTD, or ABL, all followed by additional 5-year treatment with alendronate (ALN). High-risk patients were defined as women with PMO ⩾65 years old with a prior vertebral fracture. Baseline clinical event rates, risk reductions, and patient characteristics were based on the Abaloparatide Comparator Trial in Vertebral Endpoints (ACTIVE) trial. RESULTS Over a 10-year period, the DES model yielded average total discounted per-patient costs of $10 212, $46 783, and $26 837 and quality-adjusted life-years (QALYs) of 6.742, 6.781, and 6.792 for PBO/ALN, TPTD/ALN, and ABL/ALN, respectively. Compared with TPTD/ALN, ABL/ALN accrued higher QALYs at lower cost and produced an incremental cost-effectiveness ratio (ICER) of $333 266/QALY relative to PBO/ALN. In high-risk women, ABL/ALN also had more QALYs and less cost over TPTD/ALN and yielded an ICER of $188 891/QALY relative to PBO/ALN. Conclusion and Relevance: ABL is a dominant treatment strategy over TPTD. In women with PMO at high risk of fracture, ABL is an alternative cost-effective treatment.
Collapse
Affiliation(s)
- Quang A. Le
- Western University of Health Sciences, Pomona, CA, USA
| | - Joel W. Hay
- University of Southern California, Los Angeles, CA, USA
| | | | | |
Collapse
|
14
|
Moriwaki K, Fukuda H. Cost-effectiveness of implementing guidelines for the treatment of glucocorticoid-induced osteoporosis in Japan. Osteoporos Int 2019; 30:299-310. [PMID: 30610244 DOI: 10.1007/s00198-018-4798-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022]
Abstract
UNLABELLED A model-based cost-effectiveness analysis was performed to evaluate the cost-effectiveness of implementing the clinical guideline for the treatment for glucocorticoid-induced osteoporosis (GIO). The treatment indication for GIO in the current Japanese clinical guidelines is likely to be cost-effective except for the limited patients who are at low risk for fracture. INTRODUCTION The purpose of this study was to evaluate the cost-effectiveness of implementing the clinical guideline for the treatment for glucocorticoid-induced osteoporosis (GIO) from the perspective of the Japanese healthcare system. METHODS A patient-level state transition model was developed to predict lifetime costs and quality-adjusted life years (QALYs) in postmenopausal Japanese women with osteopenia or osteoporosis using glucocorticoid (GC). An annual discount rate of 2% for both costs and QALYs was applied. The incremental cost-effectiveness ratio (ICER) of 5-year alendronate therapy compared with no therapy was estimated with different combinations of the risk factors such as starting age (45, 55, or 65), femoral neck BMD (% young adult mean (YAM) of 70%, 75%, or 80%), dose of GC (2.5, 5, or 10 mg per day), and the presence of previous fracture (yes or no). RESULTS For 55-year-old women using GC with a BMD of 75% of YAM, the ICER ranged from $10,958 to $ 29,727 per QALY. Scenario analyses indicated that the lower age, the lower BMD, the higher dose of GC, and the presence of previous fracture associated with lower ICER. The best-case scenario was 45-year-old women with a BMD of 70% of YAM, GC dose of 10 mg per day, and previous fracture, and resulted in healthcare cost-savings. The worst-case scenario was 65-year-old women with a BMD of 80% of YAM, GC dose of 2.5 mg per day, and no previous fracture, and resulted in the ICER of $66,791 per QALY. Sensitivity analyses in the worst-case scenario showed that the annual discount rate for costs and health benefit had the strong influence on the estimated ICER. Although the ICER was influenced by other parameters such as disutility due to vertebral fracture, efficacy of alendronate, and so on, the ICERs remained more than $50,000 per QALY. CONCLUSIONS The cost-effectiveness of preventive alendronate therapy for postmenopausal women with osteopenia or osteoporosis using GC is sensitive to age, BMD, GC dose, and the presence of previous fracture. Our analysis suggested that the treatment indication for postmenopausal women with osteopenia or osteoporosis using GC in the current Japanese clinical guidelines is likely to be cost-effective except for the limited patients who are at low risk for fracture.
Collapse
Affiliation(s)
- K Moriwaki
- Laboratory of Medical Statistics, Kobe Pharmaceutical University, 4-19-1, Motoyamakita, Higashinada, Kobe, 658-8558, Japan.
| | - H Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| |
Collapse
|
15
|
Liu J, Guo H, Rai P, Pinto L, Barron R. Medication persistence and risk of fracture among female Medicare beneficiaries diagnosed with osteoporosis. Osteoporos Int 2018; 29:2409-2417. [PMID: 30022254 DOI: 10.1007/s00198-018-4630-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED We examined the relationship between persistent osteoporosis medication use and fracture risk among female Medicare beneficiaries diagnosed with osteoporosis using Medicare claims, 2009-2012. Persistent use was associated with reduced risk of fracture and significantly lower total health care costs in the follow-up period. Results were consistent using different analytical methods. INTRODUCTION This study aimed to examine the relationship between medication persistence and fracture risk among female Medicare beneficiaries diagnosed with osteoporosis. METHODS Elderly female Medicare beneficiaries diagnosed with osteoporosis and initiated on osteoporosis medication January 1, 2009-June 30, 2011, were included. Persistent medication use was defined as continuous use (no gap ≥ 60 days) for 1 year or longer. The key outcome was fragility fracture. A difference-in-difference analysis was performed at the log scale of fracture rate using a Poisson regression model with months 1-6 before medication initiation as the pre-initiation period and up to 18 months after as the post-initiation period. Total health care costs were compared using a similar approach. Sensitivity analyses were conducted using different pre- and post-initiation periods. RESULTS The study included 294,369 patients; 32.9% were persistent osteoporosis medication users and 67.1% non-persistent (< 12 months continuous use). Fracture incidence rates were 16.2 per 100 patient-years pre-initiation and 4.1 post-initiation for persistent users; corresponding rates for non-persistent users were 19.0 and 7.3 per 100 patient-years. The adjusted post-/pre-initiation fracture rate ratios were 0.284 for persistent and 0.411 for non-persistent users. The ratio of the two rate ratios was 0.692 (persistent vs. non-persistent, p < 0.0001), suggesting a significantly greater fracture rate reduction for persistent users. Adjusted cost ratios were significantly lower for persistent users. Sensitivity analyses results were similar. CONCLUSIONS Persistent use of osteoporosis medications was associated with reduced risk of fracture and significantly lower total health care costs. Payers and patients would benefit from interventions aimed at improving medication persistence.
Collapse
Affiliation(s)
- J Liu
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, 701 Park Avenue, Suite S4.100, Minneapolis, MN, 55415, USA.
| | - H Guo
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, 701 Park Avenue, Suite S4.100, Minneapolis, MN, 55415, USA
| | - P Rai
- Global Health Economics, Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
- School of Pharmacy, West Virginia University, Robert C. Byrd Health Sciences Center, PO Box 9510, 1129 HSCN, Morgantown, WV, 26506, USA
| | - L Pinto
- Global Health Economics, Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - R Barron
- Global Health Economics, Amgen Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| |
Collapse
|
16
|
Abstract
OBJECTIVE To evaluate the cost-effectiveness of routine administration of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA. DESIGN Markov cohort simulation model based on published literature from a healthcare sector perspective over a lifetime horizon. SETTING Nursing homes. PARTICIPANTS A hypothetical cohort of nursing home residents aged 85 years with osteoporosis. INTERVENTIONS Two strategies were compared: (1) a single intravenous dose of zoledronic acid 5 mg and (2) usual care (supplementation of calcium and vitamin D only). PRIMARY AND SECONDARY OUTCOME MEASURES Incremental cost-effectiveness ratio (ICER), as measured by cost per quality-adjusted life year (QALY) gained. RESULTS Compared with usual care, zoledronic acid had an ICER of $207 400 per QALY gained and was not cost-effective at a conventional willingness-to-pay threshold of $100 000 per QALY gained. The results were robust to a reasonable range of assumptions about incidence, mortality, quality-of-life effects and the cost of hip fracture and the cost of zoledronic acid. Zoledronic acid had a potential to become cost-effective if a fracture risk reduction with zoledronic acid was higher than 23% or if 6-month mortality in nursing home residents was lower than 16%. Probabilistic sensitivity analysis showed that the zoledronic acid would be cost-effective in 14%, 27% and 44% of simulations at willingness-to-pay thresholds of $50 000, $100 000 or $200 000 per QALY gained, respectively. CONCLUSIONS Routine administration of single-dose zoledronic acid in nursing home residents with osteoporosis is not a cost-effective use of resources in the USA but could be justifiable in those with a favourable life expectancy.
Collapse
Affiliation(s)
- Kouta Ito
- Department of Medicine, Hebrew SeniorLife, Roslindale, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
17
|
Su Y, Lai FTT, Yip BHK, Leung JCS, Kwok TCY. Cost-effectiveness of osteoporosis screening strategies for hip fracture prevention in older Chinese people: a decision tree modeling study in the Mr. OS and Ms. OS cohort in Hong Kong. Osteoporos Int 2018; 29:1793-1805. [PMID: 29774400 DOI: 10.1007/s00198-018-4543-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/20/2018] [Indexed: 01/08/2023]
Abstract
UNLABELLED Despite the high costs of hip fracture, many governments provide limited support for osteoporosis screening. We demonstrated that osteoporosis screening by dual-energy X-ray absorptiometry (DXA) with or without pre-screening by Fracture Risk Assessment Tool (FRAX) or calcaneal ultrasound are more cost-effective than no screening in Chinese people aged 65 or over in Hong Kong. INTRODUCTION To examine the cost-effective potential osteoporosis screening strategies for hip fracture prevention in Hong Kong. METHODS Decision tree models were constructed to evaluate the cost per quality-adjusted life years (QALYs) of the different osteoporosis screening strategies followed by subsequent 5-year treatment with alendronate compared to no screening (but treat if a hip fracture occurs). The multiple osteoporosis screening strategies were composed of alternative tests and initiation age groups were evaluated with a 10-year horizon, and treatment were assigned if central dual-energy X-ray absorptiometry (DXA) T-score (at either the hip or spine) is - 2.5 or less. Strategies included DXA for all people and pre-screening with the Fracture Risk Assessment Tool (FRAX) at specific thresholds or by calcaneal quantitative ultrasonography (QUS) before taking DXA examination. All the model inputs were based on the Mr. OS and Ms. OS Hong Kong cohort; data are obtained from the Social Welfare Department or the published literature. RESULTS All of the screening strategies, including the universal screening with DXA and the pre-screening with FRAX or QUS before DXA, were consistently more cost-effective than no screening for people aged 65 years old or over. One-way sensitivity analysis with a more optimistic assumption on treatment adherence or inclusion of other major osteoporotic fractures did not change the results materially. Probabilistic sensitivity analyses showed a dominant role of pre-screening with FRAX followed by subsequent osteoporosis drug treatment in people aged 70 years old or over in Hong Kong. CONCLUSIONS Osteoporosis screening strategies based on DXA with or without pre-screening are more cost-effective compared to no screening for Chinese people aged 65 or over in Hong Kong.
Collapse
Affiliation(s)
- Y Su
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - F T T Lai
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - B H K Yip
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - J C S Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - T C Y Kwok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| |
Collapse
|
18
|
Harvey NC, McCloskey E, Kanis JA, Compston J, Cooper C. Cost-effective but clinically inappropriate: new NICE intervention thresholds in osteoporosis (Technology Appraisal 464). Osteoporos Int 2018; 29:1511-1513. [PMID: 29947864 PMCID: PMC6037288 DOI: 10.1007/s00198-018-4505-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/19/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To comment on the latest technology appraisal of the National Institute for Clinical Excellence (NICE) in osteoporosis. METHODS Review of NICE Technology Appraisal (TA464) on bisphosphonate use in osteoporosis. RESULTS The NICE appraisal on bisphosphonate use in osteoporosis indicates that treatment with oral bisphosphonates may be instituted at a FRAX 10-year probability of major osteoporotic fracture above 1%. Implementation would mean that all women aged 50 years or older are deemed eligible for treatment, a position that would increase the burden of rare long-term side effects across the population. CONCLUSION Cost-effectiveness thresholds for low-cost interventions should not be used to set intervention thresholds but rather to validate the implementation of clinically driven intervention thresholds.
Collapse
Affiliation(s)
- N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia.
| | - J Compston
- Cambridge Biomedical Campus, Cambridge, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| |
Collapse
|
19
|
Raje N, Roodman GD, Willenbacher W, Shimizu K, García-Sanz R, Terpos E, Kennedy L, Sabatelli L, Intorcia M, Hechmati G. A cost-effectiveness analysis of denosumab for the prevention of skeletal-related events in patients with multiple myeloma in the United States of America. J Med Econ 2018; 21:525-536. [PMID: 29480139 DOI: 10.1080/13696998.2018.1445634] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE A large, pivotal, phase 3 trial in patients with newly diagnosed multiple myeloma (MM) demonstrated that denosumab, compared with zoledronic acid, was non-inferior for the prevention of skeletal-related events (SREs), extended the observed median progression-free survival (PFS) by 10.7 months, and showed significantly less renal toxicity. The cost-effectiveness of denosumab vs zoledronic acid in MM in the US was assessed from societal and payer perspectives. METHODS The XGEVA Global Economic Model was developed by integrating data from the phase 3 trial comparing the efficacy of denosumab with zoledronic acid for the prevention of SREs in MM. SRE rates were adjusted to reflect the real-world incidence. The model included utility decrements for SREs, administration, serious adverse events (SAEs), and disease progression. Drug, administration, SRE management, SAEs, and anti-MM treatment costs were based on data from published studies. For the societal perspective, the model additionally included SRE-related direct non-medical costs and indirect costs. The net monetary benefit (NMB) was calculated using a willingness-to-pay threshold of US$150,000. One-way deterministic and probabilistic sensitivity analyses were conducted. RESULTS From a societal perspective, compared with zoledronic acid, the use of denosumab resulted in an incremental cost of US$26,329 and an incremental quality-adjusted life-year (QALY) of 0.2439, translating into a cost per QALY gained of US$107,939 and a NMB of US$10,259 in favor of denosumab. Results were sensitive to SRE rates and PFS parameters. LIMITATIONS Costs were estimated from multiple sources, which varied by tumor type, patient population, country, and other parameters. PFS and overall survival were extrapolated beyond the follow-up of the primary analysis using fitted parametric curves. CONCLUSION Denosumab's efficacy in delaying or preventing SREs, potential to improve PFS, and lack of renal toxicity make it a cost-effective option for the prevention of SREs in MM compared with zoledronic acid.
Collapse
Affiliation(s)
- Noopur Raje
- a Massachusetts General Hospital Cancer Center , Boston , MA , USA
| | | | - Wolfgang Willenbacher
- c Innsbruck University Hospital Internal Medicine V: Hematology & Oncology & OncoTyrol - Center of Personalized Cancer Medicine , Innsbruck , Austria
| | - Kazuyuki Shimizu
- d Department of Hematology/Oncology , National Hospital Organization Higashi Nagoya National Hospital , Nagoya , Japan
| | | | - Evangelos Terpos
- f University of Athens School of Medicine, Alexandra General Hospital , Athens , Greece
| | | | | | | | - Guy Hechmati
- i Global Health Economics, Amgen Inc , Thousand Oaks , CA , USA
| |
Collapse
|
20
|
Andronis L, Goranitis I, Bayliss S, Duarte R. Cost-Effectiveness of Treatments for the Management of Bone Metastases: A Systematic Literature Review. Pharmacoeconomics 2018; 36:301-322. [PMID: 29224174 DOI: 10.1007/s40273-017-0595-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Metastatic cancers occur when cancer cells break away from the primary tumour. One of the most common sites of metastasis is the bone, with several therapeutic options currently available for managing bone metastases. In a resource-constrained environment, policy makers and practitioners need to know which options are cost effective. OBJECTIVE The aim of this systematic review was to review and appraise published economic evaluations on treatments for the management of bone metastases. METHODS We searched eight bibliographic databases (MEDLINE, MEDLINE in Process, EMBASE, CSDR, DARE, HTA, EED and CPCI) for relevant economic evaluations published from each database's inception date until March 2017. Study selection, quality assessment and data extraction were carried out according to published guidelines. RESULTS Twenty-four relevant economic analyses were identified. Seventeen of these studies focused on bone metastases resulting from a particular type of cancer, i.e. prostate (n = 8), breast (n = 7), lung (n = 1) or renal (n = 1), while seven report results for various primary tumours. Across types of cancer, evidence suggests that bisphosphonates result in lower morbidity and improved quality of life, for an additional cost, which is typically below conventional cost-effectiveness thresholds. While denosumab leads to health gains compared with zoledronic acid, it also results in substantial additional costs and is unlikely to represent value for money. The limited literature on the radiopharmaceutical strontium-89 (Sr89) and external beam radiotherapy (EBR) suggest that these treatments are cost effective compared with no treatment. CONCLUSIONS The reviewed evidence suggests that bisphosphonate treatments are cost-effective options for bone metastases, while denosumab is unlikely to represent value for money. Evidence on EBR and Sr89 is limited and less conclusive.
Collapse
Affiliation(s)
- Lazaros Andronis
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- Office A.103, Populations, Evidence and Technologies Group, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK.
| | - Ilias Goranitis
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Bayliss
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rui Duarte
- Liverpool Reviews and Implementation Group, Department of Health Services Research, University of Liverpool, Liverpool, UK
| |
Collapse
|
21
|
Jonsson E, Hansson-Hedblom A, Ljunggren Ö, Åkesson K, Spångeus A, Kanis JA, Borgström F. A health economic simulation model for the clinical management of osteoporosis. Osteoporos Int 2018; 29:545-555. [PMID: 29196775 DOI: 10.1007/s00198-017-4325-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 11/21/2017] [Indexed: 12/26/2022]
Abstract
UNLABELLED The objective was to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice. Results showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings. INTRODUCTION The purpose of this study is to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice. METHODS The analysis was carried out using a model that simulates the individual patients considered for pharmacological treatment during 1 year and their projected osteoporosis treatment pathway, quality-adjusted life years (QALYs) and costs over their remaining lifetime. All patients regardless of treatment or no treatment were simulated. Information on current management of osteoporosis in terms of patient characteristics and treatment patterns were derived from a Swedish osteoporosis research database based on national registers and patient records. Current (standard) clinical management was compared with alternative scenarios mirroring Swedish treatment guidelines. RESULTS The national burden in terms of lost QALYs was estimated at 14,993 QALYs and the total economic cost at €776M. Scenario analyses showed that 382-3864 QALYs could be gained at a cost/QALY ranging from cost-saving to €31368, depending on the scenario. The margin of investment, i.e. the maximum amount that could be invested in the healthcare system to achieve these improvements up to the limit of the willingness to pay/QALY, was estimated at €199M on a population level (€3,634/patient). CONCLUSIONS The analysis showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings. From a cost-effectiveness perspective, there is also considerable room for investment to achieve these improvements in the management of osteoporosis.
Collapse
Affiliation(s)
- E Jonsson
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, SE, Sweden.
| | | | - Ö Ljunggren
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - K Åkesson
- Department of Clinical Sciences, Clinical and Molecular Osteoporosis Unit, Lund University, Malmö, Sweden
| | - A Spångeus
- Department of Endocrinology, Medicine and Health, Linköping University, Linköping, Sweden
| | - J A Kanis
- University of Sheffield, Sheffield, UK
- Catholic University of Australia, Melbourne, Australia
| | - F Borgström
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, SE, Sweden
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
22
|
Shapiro CL, Moriarty JP, Dusetzina S, Himelstein AL, Foster JC, Grubbs SS, Novotny PJ, Borah BJ. Cost-Effectiveness Analysis of Monthly Zoledronic Acid, Zoledronic Acid Every 3 Months, and Monthly Denosumab in Women With Breast Cancer and Skeletal Metastases: CALGB 70604 (Alliance). J Clin Oncol 2017; 35:3949-3955. [PMID: 29023215 PMCID: PMC5721226 DOI: 10.1200/jco.2017.73.7437] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Skeletal-related events (SREs) such as pathologic fracture, spinal cord compression, or the necessity for radiation or surgery to bone metastasis cause considerable morbidity, decrements in quality of life, and costs to the health care system. The results of a recent large randomized trial (Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology [CALGB/Alliance 70604]) showed that zoledronic acid (ZA) every 3 months was noninferior to monthly ZA in reducing the risks of SREs. We sought to determine the cost-effectiveness (CE) of monthly ZA, ZA every 3 months, and monthly denosumab in women with breast cancer and skeletal metastases. Methods Using a Markov model, costs per SRE avoided were calculated for the three treatments. Sensitivity analyses were performed where denosumab SRE probabilities were assumed to be 50%, 75%, and 90% lower than the ZA SRE probabilities. Quality-adjusted life-years were also calculated. The analysis was from the US payer perspective. Results The mean costs of the denosumab treatment strategy are nine-fold higher than generic ZA every 3 months. Quality-adjusted life-years were virtually identical in all the three treatment arms; hence, the optimal treatment would be ZA every 3 months because it was the least costly treatment. The sensitivity analyses showed that relative to ZA every 3 months, the incremental costs per mean SRE avoided for denosumab ranged from $162,918 to $347,655. Conclusion ZA every 3 months was more CE in reducing the risks of SRE than monthly denosumab. This analysis was one of the first to incorporate the costs of generic ZA and one of the first independent CE analyses not sponsored by either Novartis or Amgen, the makers of ZA and denosumab, respectively. ZA every 3 months is the more CE option and more reasonable alternative to monthly denosumab.
Collapse
Affiliation(s)
- Charles L. Shapiro
- Charles L. Shapiro, Icahn School of Medicine, Mt Sinai, NY; James P. Moriarty, Paul J. Novotny, and Bijan J. Borah, Mayo Clinic Cancer Center; Paul J. Novotny, Mayo Clinic, Rochester, MN; Stacie Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill, NC; Andrew L. Himelstein, Helen F. Graham Cancer Center and Research Institute; Stephen S. Grubbs, Christiana Care NCI Community Oncology Research Program, Newark, DE; and Jared C. Foster, University of Michigan, Grand Rapids, MI
| | - James P. Moriarty
- Charles L. Shapiro, Icahn School of Medicine, Mt Sinai, NY; James P. Moriarty, Paul J. Novotny, and Bijan J. Borah, Mayo Clinic Cancer Center; Paul J. Novotny, Mayo Clinic, Rochester, MN; Stacie Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill, NC; Andrew L. Himelstein, Helen F. Graham Cancer Center and Research Institute; Stephen S. Grubbs, Christiana Care NCI Community Oncology Research Program, Newark, DE; and Jared C. Foster, University of Michigan, Grand Rapids, MI
| | - Stacie Dusetzina
- Charles L. Shapiro, Icahn School of Medicine, Mt Sinai, NY; James P. Moriarty, Paul J. Novotny, and Bijan J. Borah, Mayo Clinic Cancer Center; Paul J. Novotny, Mayo Clinic, Rochester, MN; Stacie Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill, NC; Andrew L. Himelstein, Helen F. Graham Cancer Center and Research Institute; Stephen S. Grubbs, Christiana Care NCI Community Oncology Research Program, Newark, DE; and Jared C. Foster, University of Michigan, Grand Rapids, MI
| | - Andrew L. Himelstein
- Charles L. Shapiro, Icahn School of Medicine, Mt Sinai, NY; James P. Moriarty, Paul J. Novotny, and Bijan J. Borah, Mayo Clinic Cancer Center; Paul J. Novotny, Mayo Clinic, Rochester, MN; Stacie Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill, NC; Andrew L. Himelstein, Helen F. Graham Cancer Center and Research Institute; Stephen S. Grubbs, Christiana Care NCI Community Oncology Research Program, Newark, DE; and Jared C. Foster, University of Michigan, Grand Rapids, MI
| | - Jared C. Foster
- Charles L. Shapiro, Icahn School of Medicine, Mt Sinai, NY; James P. Moriarty, Paul J. Novotny, and Bijan J. Borah, Mayo Clinic Cancer Center; Paul J. Novotny, Mayo Clinic, Rochester, MN; Stacie Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill, NC; Andrew L. Himelstein, Helen F. Graham Cancer Center and Research Institute; Stephen S. Grubbs, Christiana Care NCI Community Oncology Research Program, Newark, DE; and Jared C. Foster, University of Michigan, Grand Rapids, MI
| | - Stephen S. Grubbs
- Charles L. Shapiro, Icahn School of Medicine, Mt Sinai, NY; James P. Moriarty, Paul J. Novotny, and Bijan J. Borah, Mayo Clinic Cancer Center; Paul J. Novotny, Mayo Clinic, Rochester, MN; Stacie Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill, NC; Andrew L. Himelstein, Helen F. Graham Cancer Center and Research Institute; Stephen S. Grubbs, Christiana Care NCI Community Oncology Research Program, Newark, DE; and Jared C. Foster, University of Michigan, Grand Rapids, MI
| | - Paul J. Novotny
- Charles L. Shapiro, Icahn School of Medicine, Mt Sinai, NY; James P. Moriarty, Paul J. Novotny, and Bijan J. Borah, Mayo Clinic Cancer Center; Paul J. Novotny, Mayo Clinic, Rochester, MN; Stacie Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill, NC; Andrew L. Himelstein, Helen F. Graham Cancer Center and Research Institute; Stephen S. Grubbs, Christiana Care NCI Community Oncology Research Program, Newark, DE; and Jared C. Foster, University of Michigan, Grand Rapids, MI
| | - Bijan J. Borah
- Charles L. Shapiro, Icahn School of Medicine, Mt Sinai, NY; James P. Moriarty, Paul J. Novotny, and Bijan J. Borah, Mayo Clinic Cancer Center; Paul J. Novotny, Mayo Clinic, Rochester, MN; Stacie Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill, NC; Andrew L. Himelstein, Helen F. Graham Cancer Center and Research Institute; Stephen S. Grubbs, Christiana Care NCI Community Oncology Research Program, Newark, DE; and Jared C. Foster, University of Michigan, Grand Rapids, MI
| |
Collapse
|
23
|
Cristino J, Finek J, Jandova P, Kolek M, Pásztor B, Giannopoulou C, Qian Y, Brezina T, Lothgren M. Cost-effectiveness of denosumab versus zoledronic acid for preventing skeletal-related events in the Czech Republic. J Med Econ 2017; 20:799-812. [PMID: 28485692 DOI: 10.1080/13696998.2017.1328423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS This study assessed the cost-effectiveness of the subcutaneous RANKL inhibitor, denosumab, vs the intravenous bisphosphonate, zoledronic acid, for the prevention of skeletal-related events (SREs) in patients with prostate cancer, breast cancer, and other solid tumors (OST) in the Czech Republic. MATERIALS AND METHODS A lifetime Markov model was developed to compare the effects of denosumab and zoledronic acid on costs (including drug costs and administration, patient management, SREs, and adverse events), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios from a national payer perspective. Different discount rates, time horizons, SRE rates, distributions, and nature (asymptomatic vs all SREs), and the inclusion of treatment discontinuation were considered in scenario analyses. The robustness of the model was tested using deterministic and probabilistic sensitivity analyses. RESULTS Across tumor types, denosumab was associated with fewer SREs, improved QALYs, and higher total costs over a lifetime. The incremental cost per QALY gained for denosumab vs zoledronic acid was 382,673 CZK for prostate cancer, 408,450 CZK for breast cancer, and 608,133 CZK for OST. Incremental costs per SRE avoided for the same tumor type were 54,007 CZK, 51,765 CZK, and 94,426 CZK, respectively. In scenario analyses, the results remained similar to baseline, when different discount rates and time horizons were considered. At a non-official willingness-to-pay threshold of 1.2 million CZK, the probabilities of denosumab being cost-effective vs zoledronic acid were 0.64, 0.67, and 0.49 for prostate cancer, breast cancer, and OST, respectively. LIMITATIONS The SRE rates used were obtained from clinical trials; studies suggest rates may be higher in clinical practice. Additional evidence on real-world SRE rates could further improve the accuracy of the modeling. CONCLUSIONS Compared with zoledronic acid, denosumab provides a cost-effective treatment option for the prevention of SREs in patients with prostate cancer, breast cancer, and OST in the Czech Republic.
Collapse
Affiliation(s)
| | - Jíndřich Finek
- b Pilsen Faculty Hospital, Clinic of Oncology and Radiotherapy (FN v Plzni) , Pilsen , Czech Republic
| | | | | | | | | | - Yi Qian
- e Amgen Inc. , Thousand Oaks , CA , USA
| | | | | |
Collapse
|
24
|
Majumdar SR, Lier DA, Hanley DA, Juby AG, Beaupre LA. Economic evaluation of a population-based osteoporosis intervention for outpatients with non-traumatic non-hip fractures: the "Catch a Break" 1i [type C] FLS. Osteoporos Int 2017; 28:1965-1977. [PMID: 28275838 PMCID: PMC5486946 DOI: 10.1007/s00198-017-3986-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/23/2017] [Indexed: 01/13/2023]
Abstract
UNLABELLED Fracture liaison services (FLS) are advocated to improve osteoporosis treatment after fragility fracture, but there are few economic analyses of different models. A population-based 1i [=type C] FLS for non-hip fractures was implemented and it costs $44 per patient and it was very cost-effective ($9200 per QALY gained). Small operational changes would convert it from cost-effective to cost-saving. INTRODUCTION After fragility fracture, <20% of patients receive osteoporosis treatment. FLS are recommended to address this deficit but there are very few economic analyses of different FLS models. Therefore, we conducted an economic analysis of a 1i (=type C) FLS called "Catch a Break (CaB)." METHODS CaB is a population-based FLS in Alberta, Canada, that case-finds older outpatients with non-traumatic upper extremity, spine, pelvis, or "other" non-hip fractures and provides telephonic outreach and printed educational materials to patients and their physicians. Cost-effectiveness was assessed using Markov decision-analytic models. Costs were expressed in 2014 Canadian dollars and effectiveness based on model simulations of recurrent fractures and quality-adjusted life years (QALYs). Perspective was healthcare payer; horizon was lifetime; and costs and benefits were discounted 3%. RESULTS Over 1 year, CaB enrolled 7323 outpatients (mean age 67 years, 75% female, 69% upper extremity) at average cost of $44 per patient. Compared with usual care, CaB increased rates of bisphosphonate treatment by 4.3 to 17.5% (p < 0.001). Over their lifetime, for every 10,000 patients enrolled in CaB, 4 hip fractures (14 fractures total) would be avoided and 12 QALYs gained. Compared with usual care, incremental cost-effectiveness of CaB was estimated at $9200 per QALY. CaB was cost-effective in 85% of 10,000 probabilistic simulations. Sensitivity analyses showed if "other" fractures were excluded and intervention costs reduced 25% that CaB would become cost-saving. CONCLUSIONS A relatively inexpensive population-based 1i (=type C) FLS was implemented in Alberta and it was very cost-effective. If CaB excluded "other" fractures and decreased intervention costs by 25%, it would be cost-saving, as would any FLS that was more effective and less expensive.
Collapse
Affiliation(s)
- S R Majumdar
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134 Clinical Sciences Building, 11350 - 83rd Avenue, Edmonton, Alberta, T6G 2G3, Canada.
| | - D A Lier
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134 Clinical Sciences Building, 11350 - 83rd Avenue, Edmonton, Alberta, T6G 2G3, Canada
| | - D A Hanley
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - A G Juby
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134 Clinical Sciences Building, 11350 - 83rd Avenue, Edmonton, Alberta, T6G 2G3, Canada
| | - L A Beaupre
- The Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | |
Collapse
|
25
|
Dunnewind T, Dvortsin EP, Smeets HM, Konijn RM, Bos JHJ, de Boer PT, van den Bergh JP, Postma MJ. Economic Consequences and Potentially Preventable Costs Related to Osteoporosis in the Netherlands. Value Health 2017; 20:762-768. [PMID: 28577693 DOI: 10.1016/j.jval.2017.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/01/2017] [Accepted: 02/08/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Osteoporosis often does not involve symptoms, and so the actual number of patients with osteoporosis is higher than the number of diagnosed individuals. This underdiagnosis results in a treatment gap. OBJECTIVES To estimate the total health care resource use and costs related to osteoporosis in the Netherlands, explicitly including fractures, and to estimate the proportion of fracture costs that are linked to the treatment gap and might therefore be potentially preventable; to also formulate, on the basis of these findings, strategies to optimize osteoporosis care and treatment and reduce its related costs. METHODS In this retrospective study, data of the Achmea Health Database representing 4.2 million Dutch inhabitants were used to investigate the economic consequence of osteoporosis in the Netherlands in 2010. Specific cohorts were created to identify osteoporosis-related fractures and their costs. Besides, costs of pharmaceutical treatment regarding osteoporosis were included. Using data from the literature, the treatment gap was estimated. Sensitivity analysis was performed on the base-case results. RESULTS A total of 108,013 individuals with a history of fractures were included in this study. In this population, 59,193 patients were using anti-osteoporotic medication and 86,776 patients were using preventive supplements. A total number of 3,039 osteoporosis-related fractures occurred. The estimated total costs were €465 million. On the basis of data presented in the literature, the treatment gap in our study population was estimated to vary from 60% to 72%. CONCLUSIONS The estimated total costs corrected for treatment gap were €1.15 to €1.64 billion. These results indicate room for improvement in the health care policy against osteoporosis.
Collapse
Affiliation(s)
- Tom Dunnewind
- Unit of PharmacoTherapy, -Epidemiology and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Evgeni P Dvortsin
- Unit of PharmacoTherapy, -Epidemiology and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Asc Academics B.V., Groningen, The Netherlands
| | - Hugo M Smeets
- Achmea Health Care Insurance N.V., Leusden, The Netherlands
| | - Rob M Konijn
- Achmea Health Care Insurance N.V., Leusden, The Netherlands
| | - Jens H J Bos
- Unit of PharmacoTherapy, -Epidemiology and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Pieter T de Boer
- Unit of PharmacoTherapy, -Epidemiology and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, Viecuri Medical Center, Venlo, The Netherlands; Department of Internal Medicine, University Medical Center Maastricht, Maastricht, The Netherlands; Faculty of Medicine and Life Sciences, University of Hasselt, Diepenbeek, Belgium
| | - Maarten J Postma
- Unit of PharmacoTherapy, -Epidemiology and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
26
|
Moriwaki K, Mouri M, Hagino H. Cost-effectiveness analysis of once-yearly injection of zoledronic acid for the treatment of osteoporosis in Japan. Osteoporos Int 2017; 28:1939-1950. [PMID: 28265718 PMCID: PMC5486933 DOI: 10.1007/s00198-017-3973-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/15/2017] [Indexed: 11/24/2022]
Abstract
UNLABELLED Model-based economic evaluation was performed to assess the cost-effectiveness of zoledronic acid. Although zoledronic acid was dominated by alendronate, the incremental quality-adjusted life year (QALY) was quite small in extent. Considering the advantage of once-yearly injection of zoledronic acid in persistence, zoledronic acid might be a cost-effective treatment option compared to once-weekly oral alendronate. INTRODUCTION The purpose of this study was to estimate the cost-effectiveness of once-yearly injection of zoledronic acid for the treatment of osteoporosis in Japan. METHODS A patient-level state-transition model was developed to predict the outcome of patients with osteoporosis who have experienced a previous vertebral fracture. The efficacy of zoledronic acid was derived from a published network meta-analysis. Lifetime cost and QALYs were estimated for patients who had received zoledronic acid, alendronate, or basic treatment alone. The incremental cost-effectiveness ratio (ICER) of zoledronic acid was estimated. RESULTS For patients 70 years of age, zoledronic acid was dominated by alendronate with incremental QALY of -0.004 to -0.000 and incremental cost of 430 USD to 493 USD. Deterministic sensitivity analysis indicated that the relative risk of hip fracture and drug cost strongly affected the cost-effectiveness of zoledronic acid compared to alendronate. Scenario analysis considering treatment persistence showed that the ICER of zoledronic acid compared to alendronate was estimated to be 47,435 USD, 27,018 USD, and 10,749 USD per QALY gained for patients with a T-score of -2.0, -2.5, or -3.0, respectively. CONCLUSION Although zoledronic acid is dominated by alendronate, the incremental QALY is quite small in extent. Considering the advantage of annual zoledronic acid treatment in compliance and persistence, zoledronic acid may be a cost-effective treatment option compared to alendronate.
Collapse
Affiliation(s)
- K Moriwaki
- Department of Medical Statistics, Kobe Pharmaceutical University, 4-19-1, Motoyamakita, Higashinada, Kobe, 658-8558, Japan
| | - M Mouri
- Global Health Research Coordinating Center, Kanagawa Academy of Science and Technology, KSP East 3F 309, 3-2-1, Sakado, Takatsu, Kawasaki, Kanagawa, Japan
- Project Research Institutes, Comprehensive Research Organization, Waseda University, Tokyo, 169-8050, Japan
| | - H Hagino
- School of Health Sciences, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori, 683-8503, Japan.
| |
Collapse
|
27
|
Mori T, Crandall CJ, Ganz DA. Cost-effectiveness of denosumab versus oral alendronate for elderly osteoporotic women in Japan. Osteoporos Int 2017; 28:1733-1744. [PMID: 28210776 DOI: 10.1007/s00198-017-3940-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/23/2017] [Indexed: 01/07/2023]
Abstract
UNLABELLED We constructed a Markov microsimulation model among hypothetical cohorts of community-dwelling elderly osteoporotic Japanese women without prior hip or vertebral fractures over a lifetime horizon. Compared with weekly oral alendronate for 5 years, denosumab every 6 months for 5 years is cost-saving or cost-effective at a conventionally accepted threshold. INTRODUCTION The objective of the study was to examine the cost-effectiveness of subcutaneous denosumab every 6 months for 5 years compared with weekly oral alendronate for 5 years in Japan. METHODS We calculated incremental cost-effectiveness ratios [ICERs] (2016 US dollars [$] per quality-adjusted life year [QALY]), using a Markov microsimulation model among hypothetical cohorts of community-dwelling osteoporotic Japanese women without prior hip or vertebral fractures at various ages of therapy initiation (65, 70, 75, and 80 years) over a lifetime horizon from three perspectives: societal, healthcare sector, and government. RESULTS Denosumab was cost-saving compared with alendronate at ages 75 and 80 years from any of the three perspectives. The ICERs of denosumab compared with alendronate were $25,700 and $5000 per QALY at ages 65 and 70 years from a societal perspective and did not exceed a willingness-to-pay of $50,000 per QALY from the other two perspectives. In deterministic sensitivity analyses, results were sensitive to changes in the effectiveness of denosumab for reducing hip fracture and clinical vertebral fracture and the rate ratio of non-persistence with denosumab compared to alendronate. In probabilistic sensitivity analyses, the probabilities of denosumab being cost-effective compared with alendronate were 89-100% at a willingness-to-pay of $50,000 per QALY. CONCLUSIONS Among community-dwelling elderly osteoporotic women in Japan, denosumab every 6 months for 5 years is cost-saving or cost-effective at a conventionally accepted threshold of willingness-to-pay at all ages examined, compared with weekly alendronate for 5 years. This study provides insight to clinicians and policymakers regarding the relative economic value of osteoporosis treatments in elderly women.
Collapse
Affiliation(s)
- T Mori
- Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - D A Ganz
- Geriatric Research, Education and Clinical Center and HSR&D Center for Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of Geriatrics, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
- Health Unit, RAND Corporation, Santa Monica, CA, USA
| |
Collapse
|
28
|
Caires ELP, Bezerra MC, Junqueira AFTDA, Fontenele SMDA, Andrade SCDA, d'Alva CB. Treatment of postmenopausal osteoporosis: a literature-based algorithm for use in the public health care system. Rev Bras Reumatol Engl Ed 2017; 57:254-263. [PMID: 28535898 DOI: 10.1016/j.rbre.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 12/05/2016] [Indexed: 06/07/2023] Open
Abstract
Bisphosphonates are considered first-line agents in the treatment of postmenopausal osteoporosis based on extensive experience of use, safety, and proven efficacy in reducing vertebral, non-vertebral and femur fractures. However, post-marketing reports based on the treatment of millions of patients/year over lengthy periods of time have revealed the occurrence of initially unexpected adverse effects, such as osteonecrosis of the jaw and atypical femoral fracture, leading to the restriction of treatment duration with bisphosphonates by global regulatory agencies. However, despite the association between these effects and bisphosphonates, this risk should be analyzed in the context of osteoporosis treatment, alongside the benefit of preventing osteoporotic fractures and their clinical consequences. Therefore, we consider it plausible to discuss the restriction to the use of bisphosphonates, possible indications for prolonged treatment and alternative therapies following the suspension of this drug class for patients with persistent high risk of fracture after initial treatment, especially considering the problems of public health funding in Brazil and the shortage of drugs provided by the government. Thus, to standardize the treatment of osteoporosis in the public health care system, we aim to develop a proposal for a scientifically-based pharmacological treatment for postmenopausal osteoporosis, establishing criteria for indication and allowing the rational use of each pharmacological agent. We discuss the duration of the initial bisphosphonate treatment, the therapeutic options for refractory patients and potential indications of other classes of drugs as first-choice treatment in the sphere of public health, in which assessing risk and cost effectiveness is a priority.
Collapse
Affiliation(s)
- Ellen Luz Pereira Caires
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Endocrinologia e Diabetes, Fortaleza, CE, Brazil
| | - Mailze Campos Bezerra
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Reumatologia, Fortaleza, CE, Brazil; Universidade Federal do Ceará (UFC), Faculdade de Medicina, Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Fortaleza, CE, Brazil
| | - Ana Flávia Torquato de Araújo Junqueira
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Endocrinologia e Diabetes, Fortaleza, CE, Brazil; Universidade Federal do Ceará (UFC), Faculdade de Medicina, Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Fortaleza, CE, Brazil
| | - Sheila Márcia de Araújo Fontenele
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Reumatologia, Fortaleza, CE, Brazil; Universidade Federal do Ceará (UFC), Faculdade de Medicina, Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Fortaleza, CE, Brazil
| | - Silvana Cristina de Albuquerque Andrade
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Fortaleza, CE, Brazil; Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Nefrologia e Transplante Renal, Fortaleza, CE, Brazil
| | - Catarina Brasil d'Alva
- Universidade Federal do Ceará (UFC), Faculdade de Medicina, Serviço de Endocrinologia e Diabetes, Fortaleza, CE, Brazil; Universidade Federal do Ceará (UFC), Faculdade de Medicina, Núcleo de Atendimento Multidisciplinar às Doenças Osteometabólicas, Fortaleza, CE, Brazil.
| |
Collapse
|
29
|
Andronis L, Goranitis I, Pirrie S, Pope A, Barton D, Collins S, Daunton A, McLaren D, O'Sullivan JM, Parker C, Porfiri E, Staffurth J, Stanley A, Wylie J, Beesley S, Birtle A, Brown JE, Chakraborti P, Hussain SA, Russell JM, Billingham LJ, James ND. Cost-effectiveness of zoledronic acid and strontium-89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate-refractory prostate cancer: results from the TRAPEZE trial (ISRCTN 12808747). BJU Int 2017; 119:522-529. [PMID: 27256016 DOI: 10.1111/bju.13549] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC). PATIENTS AND METHODS Data on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 × 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the National Health Service in the UK and included expenditures for trial treatments, concomitant medications, and use of related hospital and primary care services. Quality-adjusted life-years (QALYs) were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results are expressed as incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves. RESULTS The per-patient cost for ZA was £12 667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group had on average 0.03 QALYs more than their counterparts in no ZA group. The ICER for this comparison was £8 005. Sr89 was associated with a cost of £13 230, £1365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16 884. The probabilities of ZA and Sr89 being cost-effective were 0.64 and 0.60, respectively. CONCLUSIONS The addition of bone-targeting treatments to standard chemotherapy led to a small improvement in QALYs for a modest increase in cost (or cost-savings). ZA and Sr89 resulted in ICERs below conventional willingness-to-pay per QALY thresholds, suggesting that their addition to chemotherapy may represent a cost-effective use of resources.
Collapse
Affiliation(s)
| | - Ilias Goranitis
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Sarah Pirrie
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Ann Pope
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Darren Barton
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Stuart Collins
- Posthumously listed (previously CRCTU Birmingham), Birmingham, UK
| | - Adam Daunton
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Emilio Porfiri
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Staffurth
- Institute of Cancer and Genetics, Cardiff University, UK
| | | | | | | | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | | | | | | | | | - Lucinda J Billingham
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Nicholas D James
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
30
|
Sowa PM, Downes MJ, Gordon LG. Cost-effectiveness of dual-energy X-ray absorptiometry plus antiresorptive treatment in Australian women with breast cancer who receive aromatase inhibitors. J Bone Miner Metab 2017; 35:199-208. [PMID: 26969395 DOI: 10.1007/s00774-016-0742-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/22/2016] [Indexed: 11/29/2022]
Abstract
Postmenopausal women with breast cancer on aromatase inhibitor (AI) treatment are at increased risk of bone mineral density loss, which may lead to minimal trauma fractures. We examined the cost-effectiveness of dual energy X-ray absorptiometry (DXA) with antiresorptive (AR) therapy compared with fracture risk assessment, lifestyle advice, and vitamin supplementation. We used a hypothetical Markov cohort model of lifetime duration for 60-year-old women with early stage breast cancer receiving AIs. The data to inform the model came from medical literature, epidemiological reports, and costing data sets. Two eligibility scenarios for AR therapy were considered: (A) osteoporosis and (B) osteopenia or osteoporosis. The main outcomes were incremental cost per quality-adjusted life years gained and cumulative fractures per 1000 women, calculated relative to the comparator. Key aspects of the model were explored in sensitivity analyses. Due to relatively low effectiveness gains, the outcomes were primarily driven by the costs. The incremental cost per quality-adjusted life year gained was A$47,556 and A$253,000 for scenarios A and B, respectively. The numbers of fractures avoided were 56 and 77 per 1000 women, respectively. The results were most sensitive to the initial probability of osteoporosis, baseline risk of fracture, and cohort starting age. Compared with risk assessment and lifestyle advice only, a DXA scan followed by an AR treatment is potentially cost-effective for women aged 60 and over undergoing AI therapy for early breast cancer. However, the number of fractures averted through this intervention is small.
Collapse
MESH Headings
- Absorptiometry, Photon/economics
- Aromatase Inhibitors/therapeutic use
- Australia
- Bone Density/drug effects
- Bone Density Conservation Agents/economics
- Bone Density Conservation Agents/therapeutic use
- Bone Diseases, Metabolic/drug therapy
- Bone Diseases, Metabolic/economics
- Bone Diseases, Metabolic/prevention & control
- Breast Neoplasms/drug therapy
- Cost-Benefit Analysis
- Female
- Fractures, Bone/economics
- Fractures, Bone/epidemiology
- Fractures, Bone/prevention & control
- Health Care Costs
- Humans
- Markov Chains
- Middle Aged
- Osteoporosis, Postmenopausal/drug therapy
- Osteoporosis, Postmenopausal/economics
- Osteoporosis, Postmenopausal/prevention & control
- Quality-Adjusted Life Years
Collapse
Affiliation(s)
- P Marcin Sowa
- Research School of Population Health, Australian National University, Acton, ACT, 2601, Australia.
| | - Martin J Downes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, 4131, Australia
| | - Louisa G Gordon
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, 4131, Australia
| |
Collapse
|
31
|
Moriwaki K, Noto S. Economic evaluation of osteoporosis liaison service for secondary fracture prevention in postmenopausal osteoporosis patients with previous hip fracture in Japan. Osteoporos Int 2017; 28:621-632. [PMID: 27699441 DOI: 10.1007/s00198-016-3777-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 09/13/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED A model-based cost-effectiveness analysis was performed to evaluate the cost-effectiveness of secondary fracture prevention by osteoporosis liaison service (OLS) relative to no therapy in patients with osteoporosis and a history of hip fracture. Secondary fracture prevention by OLS is cost-effective in Japanese women with osteoporosis who have suffered a hip fracture. INTRODUCTION The purpose of this study was to estimate, from the perspective of Japan's healthcare system, the cost-effectiveness of secondary fracture prevention by OLS relative to no therapy in patients with osteoporosis and a history of hip fracture. METHODS A patient-level state transition model was developed to predict lifetime costs and quality-adjusted life years (QALYs) in patients with or without secondary fracture prevention by OLS. The incremental cost-effectiveness ratio (ICER) of secondary fracture prevention compared with no therapy was estimated. Sensitivity analyses were performed to examine the influence of parameter uncertainty on the base case results. RESULTS Compared with no therapy, secondary fracture prevention in patients aged 65 with T-score of -2.5 resulted in an additional lifetime cost of $3396 per person and conferred an additional 0.118 QALY, resulting in an ICER of $28,880 per QALY gained. Deterministic sensitivity analyses showed that treatment duration and offset time strongly affect the cost-effectiveness of OLS. According to the results of scenario analyses, secondary fracture prevention by OLS was cost-saving compared with no therapy in patients with a family history of hip fracture and high alcohol intake. CONCLUSIONS Secondary fracture prevention by OLS is cost-effective in Japanese women with osteoporosis who have suffered a hip fracture. In addition, secondary fracture prevention is less expensive than no therapy in high-risk patients with multiple risk factors.
Collapse
Affiliation(s)
- K Moriwaki
- Department of Medical Statistics, Kobe Pharmaceutical University, 4-19-1, Motoyamakita, Higashinada, Kobe, 658-8558, Japan.
- Center for Health Economics and QOL Research, 1398, Shimami, Kita-ku, Niigata, 950-3198, Japan.
| | - S Noto
- Center for Health Economics and QOL Research, 1398, Shimami, Kita-ku, Niigata, 950-3198, Japan
- Department of Occupational Therapy, Niigata University of Health and Welfare, 1398, Shimami, Kita-ku, Niigata, 950-3198, Japan
| |
Collapse
|
32
|
Mori T, Crandall CJ, Ganz DA. Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA. Osteoporos Int 2017; 28:585-595. [PMID: 27726000 DOI: 10.1007/s00198-016-3772-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 09/11/2016] [Indexed: 12/24/2022]
Abstract
UNLABELLED We developed a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women without prior major osteoporotic fractures over a lifetime horizon. At ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a conventionally accepted threshold compared with bisphosphonates alone. INTRODUCTION The purpose of this study was to examine the cost-effectiveness of the combined strategy of oral bisphosphonate therapy for 5 years and falls prevention exercise for 1 year compared with either strategy in isolation. METHODS We calculated incremental cost-effectiveness ratios [ICERs] (2014 US dollars per quality-adjusted life year [QALY]), using a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women with different starting ages (65, 70, 75, and 80) without prior history of hip, vertebral, or wrist fractures over a lifetime horizon from the societal perspective. RESULTS At ages 65, 70, 75, and 80, the combined strategy had ICERs of $202,020, $118,460, $46,870, and $17,640 per QALY, respectively, compared with oral bisphosphonate therapy alone. The combined strategy provided better health at lower cost than falls prevention exercise alone at ages 70, 75, and 80. In deterministic sensitivity analyses, results were particularly sensitive to the change in the opportunity cost of participants' time spent exercising. In probabilistic sensitivity analyses, the probabilities of the combined strategy being cost-effective compared with the next best alternative increased with age, ranging from 35 % at age 65 to 48 % at age 80 at a willingness-to-pay of $100,000 per QALY. CONCLUSIONS Among community-dwelling US white women ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a willingness-to-pay of $100,000 per QALY, compared with oral bisphosphonate therapy only. This analysis will help clinicians and policymakers make better decisions about treatment options to reduce fracture risk.
Collapse
Affiliation(s)
- T Mori
- Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - D A Ganz
- Geriatric Research, Education and Clinical Center and HSR&D Center for Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Health Unit, RAND Corporation, Santa Monica, CA, USA
| |
Collapse
|
33
|
Ni W, Jiang Y. Evaluation on the cost-effective threshold of osteoporosis treatment on elderly women in China using discrete event simulation model. Osteoporos Int 2017; 28:529-538. [PMID: 27581955 DOI: 10.1007/s00198-016-3751-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/19/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED This study used a simulation model to determine the cost-effective threshold of fracture risk to treat osteoporosis among elderly Chinese women. Osteoporosis treatment is cost-effective among average-risk women who are at least 75 years old and above-average-risk women who are younger than 75 years old. INTRODUCTION Aging of the Chinese population is imposing increasing economic burden of osteoporosis. This study evaluated the cost-effectiveness of osteoporosis treatment among the senior Chinese women population. METHODS A discrete event simulation model using age-specific probabilities of hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture; costs (2015 US dollars); and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment. Incremental cost-effectiveness ratio (ICER) was calculated. The willingness to pay (WTP) for a QALY in China was compared with the calculated ICER to decide the cost-effectiveness. To determine the absolute 10-year hip fracture probability at which the osteoporosis treatment became cost-effective, average age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until the WTP threshold was observed for treatment relative to no intervention. Sensitivity analyses were also performed to evaluate the impacts from WTP and annual treatment costs. RESULTS In baseline analysis, simulated ICERs were higher than the WTP threshold among Chinese women younger than 75, but much lower than the WTP among the older population. Sensitivity analyses indicated that cost-effectiveness could vary due to a higher WTP threshold or a lower annual treatment cost. A 30 % increase in WTP or a 30 % reduction in annual treatment costs will make osteoporosis treatment cost-effective for Chinese women population from 55 to 85. CONCLUSIONS The current study provides evidence that osteoporosis treatment is cost-effective among a subpopulation of Chinese senior women. The results also indicate that the cost-effectiveness of using osteoporosis treatment is sensitive to the WTP threshold and annual treatment costs.
Collapse
Affiliation(s)
- W Ni
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, 635 Downey Way, VPD Suite 210, Los Angeles, CA, 90089-3333, USA
| | - Y Jiang
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, 635 Downey Way, VPD Suite 210, Los Angeles, CA, 90089-3333, USA.
| |
Collapse
|
34
|
Yoshimura M, Moriwaki K, Noto S, Takiguchi T. A model-based cost-effectiveness analysis of osteoporosis screening and treatment strategy for postmenopausal Japanese women. Osteoporos Int 2017; 28:643-652. [PMID: 27743068 DOI: 10.1007/s00198-016-3782-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/22/2016] [Indexed: 01/09/2023]
Abstract
UNLABELLED Although an osteoporosis screening program has been implemented as a health promotion project in Japan, its cost-effectiveness has yet to be elucidated fully. We performed a cost-effectiveness analysis and found that osteoporosis screening and treatment would be cost-effective for Japanese women over 60 years. INTRODUCTION The purpose of this study was to estimate the cost-effectiveness of osteoporosis screening and drug therapy in the Japanese healthcare system for postmenopausal women with no history of fracture. METHODS A patient-level state transition model was developed to predict the outcomes of Japanese women with no previous fracture. Lifetime costs and quality-adjusted life years (QALYs) were estimated for women who receive osteoporosis screening and alendronate therapy for 5 years and those who do not receive the screening and treatments. The incremental cost-effectiveness ratio (ICER) of the screening option compared with the no screening option was estimated. Sensitivity analyses were performed to examine the influence of parameter uncertainty on the base case results. RESULTS The ICERs of osteoporosis screening and treatments for Japanese women aged 50-54, 55-59, 60-64, 65-69, 70-74, and 75-79 years were estimated to be $89,242, $64,010, $40,596, $27,697, $17,027, and $9771 per QALY gained, respectively. Deterministic sensitivity analyses showed that several parameters such as the disutility due to vertebral fracture had a significant influence on the base case results. Applying a willingness to pay of $50,000 per QALY gained, the probability that the screening option became cost-effectiveness estimated to 50.9, 56.3, 59.1, and 64.7 % for women aged 60-64, 65-69, 70-74, and 75-79 years, respectively. Scenario analyses showed that the ICER for women aged 55-59 years with at least one clinical risk factor was below $50,000 per QALY. CONCLUSIONS In conclusion, dual energy X-ray absorptiometry (DXA) screening and alendronate therapy for osteoporosis would be cost-effective for postmenopausal Japanese women over 60 years. In terms of cost-effectiveness, the individual need for osteoporosis screening should be determined by age and clinical risk factors.
Collapse
Affiliation(s)
- M Yoshimura
- Field of Health Informatics and Business Administration, Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami, Kita-ku, Niigata, 950-3198, Japan
- Crecon Medical Assessment Inc, The Pharmaceutical Society of Japan, Nagai Memorial, 2-12-15, Shibuya, Shibuya-ku, Tokyo, 150-0002, Japan
| | - K Moriwaki
- Department of Medical Statistics, Kobe Pharmaceutical University, 4-19-1 Motoyamakita, Higashinada, Kobe, 658-8558, Japan.
- Center for Health Economics and QOL Research, 1398 Shimami, Kita-ku, Niigata, 950-3198, Japan.
| | - S Noto
- Center for Health Economics and QOL Research, 1398 Shimami, Kita-ku, Niigata, 950-3198, Japan
- Department of Occupational Therapy, Niigata University of Health and Welfare, 1398 Shimami, Kita-ku, Niigata, 950-3198, Japan
| | - T Takiguchi
- Field of Health Informatics and Business Administration, Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami, Kita-ku, Niigata, 950-3198, Japan
| |
Collapse
|
35
|
Abstract
UNLABELLED There is a strong impetus to prevent and treat osteoporosis to prevent fractures. $990 million dollars was spent on anti-osteoporosis drugs in 2013. As we shift our focus on primary prevention of fractures, providers are encouraged to find the most cost-effective anti-osteoporosis therapy for patients. PURPOSE Osteoporosis is a major global problem with osteoporotic fractures posing a potentially avoidable burden on healthcare resources. We studied the utilization and cost of anti-osteoporotic therapy using the 2013 Medicare Part D data. METHODS Descriptive data were produced from Microsoft Excel and SPSS regarding the anti-osteoporotic drugs of interest. RESULTS In total, Medicare and its beneficiaries spent approximately $990 million on anti-osteoporotic therapy in 2013. Despite this cost, only one in two adults with osteoporosis aged 65 and older received a prescription for an anti-osteoporosis drug. $756 million (77 %) was attributable to brand name drugs which accounted for 2,459,931 claims (22 %). Generic dispensing rate varied from 57-86 % (mean 77 ± 6) across the different states in the USA. States that mandate substitution with generic equivalents had a higher generic dispensing rate compared to the states that permit generic substitution (92 vs. 90 %; p < 0.05). After adjusting for claim counts, we found that if the states that permit substitution with generic equivalents showed the same generic dispensing rate of 92 % as the states that mandate such substitution, there is a potential for savings of $7.5 million, approximately 9 % of the total expenditure in these states on oral bisphosphonates alone. Thirty-eight percent of the total prescriptions from orthopedic surgeons were for Forteo® or Prolia® compared to 12.5 % from specialists. CONCLUSIONS These findings highlight the need for ongoing training for physicians who engage in the care of patients with osteoporosis to manage the disease in a cost-effective manner.
Collapse
Affiliation(s)
- Smita Jha
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Drive, Bldg 10-CRC, Room 4-1341, Bethesda, MD, USA.
| | - Timothy Bhattacharyya
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Drive, Bldg 10-CRC, Room 4-1341, Bethesda, MD, USA
| |
Collapse
|
36
|
Marques A, Lourenço Ó, Ortsäter G, Borgström F, Kanis JA, da Silva JAP. Cost-Effectiveness of Intervention Thresholds for the Treatment of Osteoporosis Based on FRAX(®) in Portugal. Calcif Tissue Int 2016; 99:131-41. [PMID: 27016370 DOI: 10.1007/s00223-016-0132-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/14/2016] [Indexed: 12/21/2022]
Abstract
Cost-effective intervention thresholds (ITs) based on FRAX(®) were determined for Portugal. Assuming a willingness to pay (WTP) of €32,000 per quality-adjusted life years (QALYs), treatment with generic alendronate is cost effective for men and women aged 50 years or more, with 10-year probabilities for major osteoporotic fractures and hip above 8.8 and 2.5 %, respectively. The aim of the present study was to identify the 10-year probabilities of a major and hip osteoporotic fracture using FRAX(®) validated for Portugal, above which pharmacologic interventions become cost effective in the Portuguese context. A previously developed and validated state transition Markov cohort model was populated with epidemiologic, economic and quality-of-life fracture data from Portugal. Cost-effectiveness of FRAX(®)-based ITs was calculated for generic alendronate and proprietary zoledronic acid, denosumab and teriparatide were compared to "no intervention", assuming a WTP of €32,000 (two times national Gross Domestic Product per capita) per QALYs. In the Portuguese epidemiological and economic context, treatment with generic alendronate was cost effective for men and women aged 50 years or more, with 10-year probabilities at or above 8.8 % for major osteoporotic fractures and 2.5 % for hip fractures. Cost-effective threshold 10-year probabilities for major osteoporotic and hip fractures were higher for zoledronic acid (20.4 and 10.1 %), denosumab (34.9 and 10.1 %) and teriparatide (77.8 and 62.6 %), respectively. A tool is provided to perform the calculation of cost-effective ITs for different medications, according to age group and diverse levels of WTP. Cost-effective ITs, for different medications, age groups and WTP, based on 10-year probabilities of major and hip fracture probabilities calculated with FRAX are provided.
Collapse
Affiliation(s)
- Andréa Marques
- Rheumatology Department, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal.
- Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal.
| | - Óscar Lourenço
- Faculty of Economics, Centro de Estudos e Investigação em Saúde da Universidade de Coimbra, University of Coimbra, Coimbra, Portugal
| | - Gustaf Ortsäter
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden
| | | | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - José António P da Silva
- Rheumatology Department, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
37
|
Makras P, Galanos A, Rizou S, Anastasilakis AD, Lyritis GP. Development and validation of an osteoporosis treatment questionnaire (OSTREQ) evaluating physicians' criteria in the choice of treatment. Hormones (Athens) 2016; 15:413-422. [PMID: 27394706 DOI: 10.14310/horm.2002.1684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 06/01/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This article describes the development and validation of the osteoporosis treatment questionnaire (OSTREQ), which is a physician-reported outcome tool aiming to evaluate physicians' criteria in the choice of osteoporosis treatment. DESIGN The questionnaire -named OSTREQ- consisting of 17 questions that were divided into eight sections "Health Care System", "Patients' Preference in administration routes", "Usage, Cost", "Severity of Disease", "Treatment Efficacy", "Safety Profile", "Pharmaceutical Industry", affecting the decision and overall execution of a therapeutic approach, was developed by an expert panel and was later officially translated into English. In the second phase, orthopedic surgeons were asked to complete OSTREQ. Six indirect methods to evaluate validity were adopted: exploratory factor analysis, confirmatory factor analysis, subscale validity, known group validity, floor or ceiling effects, interpretability. To assess the reliability of the questionnaire, internal consistency validity as well as test-retest and parallel forms were calculated. RESULTS One hundred seventy-two orthopedic surgeons were interviewed with an average period of experience in clinical practice of 10.5 years (SD ±8.9 years). The factors "Severity of Disease" and "Treatment Efficacy" were the most important in the choice of osteoporosis treatment, while the factor "Pharmaceutical Industry" had the least impact. The methodology of validation proved that the questionnaire possesses construct validity, discriminate ability, reliability, and sensitivity to change. CONCLUSIONS OSTREQ represents a comprehensive and focused tool that, for the first time, assesses physicians' criteria in the choice of osteoporosis treatment. This tool could assist health care systems and pharmaceutical companies to be aware which parameters drive physicians' preferences regarding osteoporosis treatment.
Collapse
Affiliation(s)
- Polyzois Makras
- Dept. of Endocrinology and Diabetes, 251 Hellenic Air Force & VA General Hospital, 3 Kanellopoulou street, 115 25, Goudi Athens, Greece.
| | - Antonios Galanos
- Laboratory for the Research of the Musculoskeletal System, University of Athens, Athens, Greece
| | | | | | | |
Collapse
|
38
|
Veszelyné Kotan E, Mészáros Á. [Bisphosphonate use and related pharmaceutical issues II]. Acta Pharm Hung 2016; 86:23-34. [PMID: 27295874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Bisphosphonates have basic role in decreasing progression of malignant bone processes as well as in the prevention and therapy of osteoporosis. Use of bisphosphonates is common in Hungary since 20 years. In the past decade their reimbursement has been changed several times, the use of generics decreased the price of bisphosphonates. In this paper we analyze the consumption of prescribed bisphosphonates in Hungary. DATA Prescription data of the National Health Insurance Fund of Hungary. METHOD We analysed the prescribed bisphosphonates between 2006-2014. We examined the type and amount of bisphosphonates used by years. After identifying therapy areas of use, we calculated the years of therapy from the DOT data. From this data we estimated the mean bisphosphonate therapy costs and costs falling for the patients. Changes in the reimbursement system regarding these medications was analysed. RESULTS Bisphosphonate years of therapy was decreasing in osteoporosis over the 9 years examined. In oncology bisphosphonate use shows stability in drug consumption. In both therapeutic areas the proportion in therapy choice of specific bisphosphonates has changed. Bisphosphonate reimbursement costs paid by the Hungarian reimbursement system was approx. 8 billion HUF in osteoporosis and 4,7 billion HUF in oncology in 2006. Changes of the reimbursement strategy, the compulsory generic use and decreasing consumption in osteoporosis has significantly reduced the overall costs by 2014. CONCLUSION According to our results bisphpsphonate use in oncology is moderate in Hungary, a decreasing consumption can be detected in osteoporosis, that is still expected to decrease. The use of generics reduced bisphosphonate therapy costs and also overall health care costs. In osteoporosis patients cost have substantially lowered.
Collapse
|
39
|
Yong JHE, Masucci L, Hoch JS, Sujic R, Beaton D. Cost-effectiveness of a fracture liaison service--a real-world evaluation after 6 years of service provision. Osteoporos Int 2016; 27:231-40. [PMID: 26275439 DOI: 10.1007/s00198-015-3280-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 08/05/2015] [Indexed: 11/24/2022]
Abstract
UNLABELLED The cost-effectiveness of a less intensive fracture liaison service is unknown. We evaluated a fracture liaison service that had been educating and referring patients for secondary prevention of osteoporotic fractures for 6 years. Our results suggest that a less intensive fracture liaison service, with moderate effectiveness, can still be worthwhile. INTRODUCTION Fragility fractures are common among older patients; the risk of re-fracture is high but could be reduced with treatments; different versions of fracture liaison service have emerged to reduce recurrent osteoporotic fractures. But the cost-effectiveness of a less intensive model is unknown. The objective of this study was to assess the cost-effectiveness of the Ontario Fracture Clinic Screening program, a fracture liaison service that had been educating and referring fragility fracture patients across Ontario, Canada to receive bone mineral density testing and osteoporosis treatments since 2007. METHODS We developed a Markov model to assess the cost-effectiveness of the program over the patients' remaining lifetime, using rates of bone mineral density testing and osteoporosis treatment and cost of intervention from the program, and supplemented it with the published literature. The analysis took the perspective of a third-party health-care payer. Costs and benefits were discounted at 5 % per year. Sensitivity analyses assessed the effects of different assumptions on the results. RESULTS The program improved quality-adjusted life-years (QALYs) by 4.3 years and led to increased costs of CAD $83,000 for every 1000 patients screened, at a cost of $19,132 per QALY gained. The enhanced model, the Bone Mineral Density (BMD) Fast Track program that includes ordering bone mineral density testing, was even more cost-effective ($5720 per QALY gained). CONCLUSIONS The Ontario Fracture Clinic Screening program appears to be a cost-effective way to reduce recurrent osteoporotic fractures.
Collapse
Affiliation(s)
- J H E Yong
- Centre for Excellence in Economic Analysis Research (CLEAR), The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - L Masucci
- Centre for Excellence in Economic Analysis Research (CLEAR), The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
| | - J S Hoch
- Centre for Excellence in Economic Analysis Research (CLEAR), The HUB Health Research Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
| | - R Sujic
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - D Beaton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
- Musculoskeletal Health & Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| |
Collapse
|
40
|
Patil R, Kolu P, Raitanen J, Valvanne J, Kannus P, Karinkanta S, Sievänen H, Uusi-Rasi K. Cost-effectiveness of vitamin D supplementation and exercise in preventing injurious falls among older home-dwelling women: findings from an RCT. Osteoporos Int 2016. [PMID: 26205890 DOI: 10.1007/s00198-015-3240-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older home-dwelling Finnish women. Given a willingness to pay of €3,000 per injurious fall prevented, the exercise intervention had an 86 % probability of being cost-effective in this population. INTRODUCTION The costs of falling in older persons are high, both to the individual and to society. Both vitamin D and exercise have been suggested to reduce the risk of falls. This study assessed the cost-effectiveness of vitamin D supplementation and exercise, separately and combined, in preventing medically attended injurious falls among older Finnish women. METHODS Economic evaluation was based on the results of a previously published 2-year randomized controlled trial (RCT) where 409 community-dwelling women aged 70 to 80 years were recruited into four groups: (1) no exercise + placebo (D-Ex-), (2) no exercise + vitamin D 800 IU/day (D+Ex-), (3) exercise + placebo (D-Ex+), and (4) exercise + vitamin D 800 IU/day (D+Ex+). The outcomes were medically attended injurious falls and fall-related health care utilization costs over the intervention period, the latter evaluated from a societal perspective based on 2011 unit costs. Incremental cost-effectiveness ratios (ICER) were calculated for the number of injurious falls per person-year prevented and uncertainty estimated using bootstrapping. RESULTS Incidence rate ratios (95 % CI) for medically attended injurious falls were lower in both Ex+ groups compared with D-Ex-: 0.46 (0.22 to 0.95) for D-Ex+, 0.38 (0.17 to 0.81) for D+Ex+. Step-wise calculation of ICERs resulted in exclusion of D+Ex- as more expensive and less effective. Recalculated ICERs were €221 for D-Ex-, €708 for D-Ex+, and €3,820 for D+Ex+; bootstrapping indicated 93 % probability that each injurious fall avoided by D-Ex+ per person year costs €708. At a willingness to pay €3,000 per injurious fall prevented, there was an 85.6 % chance of the exercise intervention being cost-effective in this population. CONCLUSIONS Exercise was effective in reducing fall-related injuries among community-dwelling older women at a moderate cost. Vitamin D supplementation had marginal additional benefit. The results provide a firm basis for initiating feasible and cost-effective exercise interventions in this population.
Collapse
Affiliation(s)
- R Patil
- The UKK Institute for Health Promotion Research, P.O. Box 30, 33501, Tampere, Finland.
| | - P Kolu
- The UKK Institute for Health Promotion Research, P.O. Box 30, 33501, Tampere, Finland
| | - J Raitanen
- The UKK Institute for Health Promotion Research, P.O. Box 30, 33501, Tampere, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - J Valvanne
- School of Medicine, University of Tampere, Tampere, Finland
- Purchasing Committee for the Promotion of Senior Citizens' Welfare, Tampere, Finland
- Gerontology Research Center, Universities of Jyväskylä and Tampere, Jyväskylä, Finland
- Department of Internal and Respiratory Medicine, Tampere University Hospital, Tampere, Finland
| | - P Kannus
- The UKK Institute for Health Promotion Research, P.O. Box 30, 33501, Tampere, Finland
- School of Medicine, University of Tampere, Tampere, Finland
- Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - S Karinkanta
- The UKK Institute for Health Promotion Research, P.O. Box 30, 33501, Tampere, Finland
| | - H Sievänen
- The UKK Institute for Health Promotion Research, P.O. Box 30, 33501, Tampere, Finland
| | - K Uusi-Rasi
- The UKK Institute for Health Promotion Research, P.O. Box 30, 33501, Tampere, Finland
- Research Department, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
41
|
Kung AWC, McGhee SM, Tsang SWY, So J, Chau J. Cost-effective osteoporosis intervention thresholds for Hong Kong postmenopausal women. Hong Kong Med J 2015; 21 Suppl 6:13-16. [PMID: 26645876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Affiliation(s)
- A W C Kung
- Department of Medicine, The University of Hong Kong
| | - S M McGhee
- Department of Community Medicine, School of Public Health, The University of Hong Kong
| | - S W Y Tsang
- Department of Medicine, The University of Hong Kong
| | - J So
- Department of Community Medicine, School of Public Health, The University of Hong Kong
| | - J Chau
- Department of Community Medicine, School of Public Health, The University of Hong Kong
| |
Collapse
|
42
|
Moriwaki K. [Cost-effectiveness considerations in the treatment of osteoporosis]. Nihon Rinsho 2015; 73:1754-1759. [PMID: 26529942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Osteoporotic fractures are associated with increased morbidity and mortality, and impose a huge financial burden on healthcare systems. Preventing osteoporotic fractures in the elderly therefore represents an important issue in terms of health economics. To date, the efficacy and cost-effectiveness of osteoporosis treatments have been studied extensively. In this article, the basic idea of health economic evaluation was introduced and articles of cost-effectiveness analysis for osteoporosis treatment were reviewed.
Collapse
|
43
|
Abstract
OBJECTIVES To evaluate the health outcomes and economics associated with the current guidance relating to the prevention of falls in the elderly through vitamin D supplementation. SETTING UK. PARTICIPANTS UK population aged 60 years and above. INTERVENTIONS A Markov health state transition model simulated patient transitions between key fall-related outcomes using a 5-year horizon and annual cycles to assess the costs and benefits of empirical treatment with colecalciferol 800 iu daily. PRIMARY AND SECONDARY OUTCOME MEASURES Costs and health outcomes attributable to fall prevention following vitamin D supplementation. RESULTS Our model shows that treating the UK population aged 60 years and above with 800 iu colecalciferol would, over a 5-year period: (1) prevent in excess of 430,000 minor falls; (2) avoid 190,000 major falls; (3) prevent 1579 acute deaths; (4) avoid 84,000 person-years of long-term care and (5) prevent 8300 deaths associated with increased mortality in long-term care. The greatest gains are seen among those 75 years and older. Based on reduction in falls alone, the intervention in all adults aged 65+ is cost-saving and leads to increased quality adjusted life years. Treating all adults aged 60+ incurs an intervention cost of £2.70bn over 5 years, yet produces a -£3.12bn reduction in fall-related costs; a net saving of £420M. Increasing the lower bound age limit by 5-year increments increases budget impact to -£1.17bn, -£1.75bn, and -£2.06bn for adults 65+, 70+ and 75+, respectively. CONCLUSIONS This study shows that treatment of the elderly UK population with colecalciferol 800 iu daily would be associated with reductions in mortality and substantial cost-savings through fall prevention.
Collapse
Affiliation(s)
- C D Poole
- Cochrane Institute for Primary Care & Public Health, Cardiff University, Cardiff, UK
| | - J Smith
- Torbay General Hospital, Torquay, Devon, UK
| | - J S Davies
- Centre for Diabetes and Endocrinology, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
44
|
Rossini M, Orsolini G, Viapiana O, Adami S, Gatti D. Bisphosphonates in the treatment of glucocorticoid-induced osteoporosis: pros. Endocrine 2015; 49:620-7. [PMID: 25649760 DOI: 10.1007/s12020-014-0506-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 12/05/2014] [Indexed: 12/12/2022]
Abstract
In glucocorticoid-induced osteoporosis (GIO), both bone formation and resorption are altered, however, with a relative prevalence of resorption, consistent with the positive results that have been reported with bisphosphonate treatment. Many studies have investigated the effect of bisphosphonates (BPs), a widely used class of anti-resorptive drugs, showing a positive effect on bone mineral density and fracture risk. Also in case of postmenopausal osteoporosis, the safety and cost-effectiveness profile of BPs in GIO appears good. Currently, the use of BPs is recommended at the earliest by all major scientific societies in postmenopausal women and men ≥50 years at high risk of fracture receiving glucocorticoid therapy. BPs are the most commonly used anti-osteoporotic agents and they remain the current standard of care for GIO.
Collapse
Affiliation(s)
- Maurizio Rossini
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy,
| | | | | | | | | |
Collapse
|
45
|
Makras P, Athanasakis K, Boubouchairopoulou N, Rizou S, Anastasilakis AD, Kyriopoulos J, Lyritis GP. Cost-effective osteoporosis treatment thresholds in Greece. Osteoporos Int 2015; 26:1949-57. [PMID: 25740208 DOI: 10.1007/s00198-015-3055-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/28/2015] [Indexed: 01/29/2023]
Abstract
UNLABELLED A Greek-specific cost-effectiveness analysis determined the FRAX-based intervention thresholds. Assuming a willingness to pay of 30,000 <euro>, osteoporosis treatment is cost-effective in subjects under the age of 75 with 10-year probabilities for hip and major osteoporotic fractures of 2.5 and 10 %, respectively, while for older patients, the same thresholds are raised to 5 and 15 %. INTRODUCTION The purpose of this study was to determine the FRAX calculated fracture probabilities at which therapeutic intervention can be considered as cost-effective in the Greek setting. METHODS A Markov cohort model was populated with Greek data, and quality-adjusted life years (QALYs) were used to calculate the cost-effective thresholds for an annual medication cost of 733.7 <euro> by gender and age. Average FRAX-based 10-year probabilities for both major osteoporotic and hip fractures were multiplied by the model-derived relative risk at which a cost of 30,000 <euro> for each QALY gained was observed for treatment versus to no intervention. RESULTS A biphasic intervention threshold model is supported by our findings. Osteoporosis treatment becomes cost-effective when absolute 10-year probabilities for hip and major osteoporotic fractures reach 2.5 and 10 %, respectively, among both men and women under the age of 75. For older subjects, the proposed intervention thresholds are raised to 5 and 15 % 10-year probability for hip and major osteoporotic fractures, respectively. CONCLUSIONS Cost-effective osteoporosis treatment may be facilitated in Greece if FRAX algorithm is used to identify subjects with 10-year probabilities for hip and major osteoporotic fractures of 2.5 and 10 %, under the age of 75, while for older patients, the relevant thresholds are 5 and 15 %, respectively.
Collapse
Affiliation(s)
- P Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force General Hospital, Athens, Greece,
| | | | | | | | | | | | | |
Collapse
|
46
|
Si L, Winzenberg TM, Jiang Q, Palmer AJ. Screening for and treatment of osteoporosis: construction and validation of a state-transition microsimulation cost-effectiveness model. Osteoporos Int 2015; 26:1477-89. [PMID: 25567776 DOI: 10.1007/s00198-014-2999-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 12/09/2014] [Indexed: 03/28/2023]
Abstract
UNLABELLED This study aimed to document and validate a new cost-effectiveness model of osteoporosis screening and treatment strategies. The state-transition microsimulation model demonstrates strong internal and external validity. It is an important tool for researchers and policy makers to test the cost-effectiveness of osteoporosis screening and treatment strategies. INTRODUCTION The objective of this study was to document and validate a new cost-effectiveness model of screening for and treatment of osteoporosis. METHODS A state-transition microsimulation model using a lifetime horizon was constructed with seven Markov states (no history of fractures, hip fracture, vertebral fracture, wrist fracture, other fracture, postfracture state, and death) describing the most important clinical outcomes of osteoporotic fractures. Tracker variables were used to record patients' history, such as fracture events, duration of treatment, and time since last screening. The model was validated for Chinese postmenopausal women receiving screening and treatment versus no screening. Goodness-of-fit analyses were performed for internal and external validation. External validity was tested by comparing life expectancy, osteoporosis prevalence rate, and lifetime and 10-year fracture risks with published data not used in the model. RESULTS The model represents major clinical facets of osteoporosis-related conditions. Age-specific hip, vertebral, and wrist fracture incidence rates were accurately reproduced (the regression line slope was 0.996, R(2) = 0.99). The changes in costs, effectiveness, and cost-effectiveness were consistent with changes in both one-way and probabilistic sensitivity analysis. The model predicted life expectancy and 10-year any major osteoporotic fracture risk at the age of 65 of 19.01 years and 13.7%, respectively. The lifetime hip, clinical vertebral, and wrist fracture risks at age 50 were 7.9, 29.8, and 18.7% respectively, all consistent with reported data. CONCLUSIONS Our model demonstrated good internal and external validity, ensuring it can be confidently applied in economic evaluations of osteoporosis screening and treatment strategies.
Collapse
Affiliation(s)
- L Si
- Menzies Research Institute Tasmania, University of Tasmania, Medical Science 1 Building, 17 Liverpool St (Private Bag 23), Hobart, TAS, 7000, Australia,
| | | | | | | |
Collapse
|
47
|
Yates CJ, Chauchard MA, Liew D, Bucknill A, Wark JD. Bridging the osteoporosis treatment gap: performance and cost-effectiveness of a fracture liaison service. J Clin Densitom 2015; 18:150-6. [PMID: 25797867 DOI: 10.1016/j.jocd.2015.01.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/07/2015] [Accepted: 01/15/2015] [Indexed: 11/13/2022]
Abstract
Individuals who sustain fragility fractures are at high risk of refracture. However, osteoporosis treatment rates remain low for these patients. Therefore, we aimed to assess the performance and cost-effectiveness of introducing a fracture liaison service (FLS) into a tertiary hospital. In "nonhospitalized" ambulatory patients who had sustained fragility fractures, we assessed baseline osteoporosis investigation and treatment rates, and subsequently, the impact of introducing an orthopedic osteoporosis policy and an FLS. Outcomes measured were uptake of osteoporosis intervention, patient satisfaction, and quality-adjusted life years (QALYs) gained. QALYs were calculated over 5 years using predicted fracture risks without intervention and estimated fracture risk reduction with intervention. At baseline (n = 49), 2% of ambulatory patients who had sustained fragility fractures underwent dual-energy X-ray absorptiometry (DXA) and 6% received osteoporosis-specific medication. After introduction of an osteoporosis policy (n = 58), 28% were investigated with DXA (p < 0.0001). However, treatment rates were unchanged. An FLS was introduced, reviewing 203 new patients over the inaugural 2 years (mean age [standard deviation], 67 (11) years; 77% female). All underwent DXA, and criteria for osteoporosis and osteopenia were identified in 44% and 40%, respectively. Osteoporosis medications were prescribed to 61% patients (risedronate: 22%, alendronate: 16%, strontium ranelate: 13%, zoledronic acid: 8%, other: 2%). Eighty-five of 90 questionnaire respondents were very satisfied or satisfied with the FLS. With the treatment prescribed over 5 years, we conservatively estimated that this FLS would reduce nonvertebral refractures from 59 to 50, improving QALYs by 0.054 and costing $1716 per patient (incremental cost-effectiveness ratio: $31749). This FLS model improves uptake of osteoporosis intervention guidelines, is popular among patients, and improves cost-effectiveness. Thus, it has the capacity to substantially improve health in a cost-effective way.
Collapse
Affiliation(s)
- Christopher J Yates
- Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne (Royal Melbourne Hospital), Parkville, Victoria, Australia.
| | - Marie-Anne Chauchard
- Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia; School of Pharmacy, University of Limoges, Limoges, France
| | - Danny Liew
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Parkville, Victoria, Australia
| | - Andrew Bucknill
- Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - John D Wark
- Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne (Royal Melbourne Hospital), Parkville, Victoria, Australia
| |
Collapse
|
48
|
Hiligsmann M, Evers SM, Ben Sedrine W, Kanis JA, Ramaekers B, Reginster JY, Silverman S, Wyers CE, Boonen A. A systematic review of cost-effectiveness analyses of drugs for postmenopausal osteoporosis. Pharmacoeconomics 2015; 33:205-24. [PMID: 25377850 DOI: 10.1007/s40273-014-0231-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Given the limited availability of healthcare resources and the recent introduction of new anti-osteoporosis drugs, the interest in the cost effectiveness of drugs in postmenopausal osteoporosis remains and even increases. OBJECTIVE This study aims to identify all recent economic evaluations on drugs for postmenopausal osteoporosis, to critically appraise the reporting quality, and to summarize the results. METHODS A literature search using Medline, the National Health Service Economic Evaluation database and the Cost-Effectiveness Analysis Registry was undertaken to identify original articles published between January 1, 2008 and December 31, 2013. Studies that assessed cost effectiveness of drugs in postmenopausal osteoporosis were included. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to assess the quality of reporting of these articles. RESULTS Of 1,794 articles identified, 39 studies fulfilled the inclusion criteria. They were conducted in 14 different countries and nine active interventions were assessed. When compared with no treatment, active osteoporotic drugs were generally cost effective in postmenopausal women aged over 60-65 years with low bone mass, especially those with prior vertebral fractures. Key drivers of cost effectiveness included individual fracture risk, medication adherence, selected comparators and country-specific analyses. Quality of reporting varied between studies with an average score of 17.9 out of 24 (range 7-21.5). CONCLUSION This review found a substantial number of published cost-effectiveness analyses of drugs in osteoporosis in the last 6 years. Results and critical appraisal of these articles can help decision makers when prioritizing health interventions and can inform the development of future economic evaluations.
Collapse
Affiliation(s)
- Mickaël Hiligsmann
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands,
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Affiliation(s)
- Haakon E Meyer
- Norwegian Institute of Public Health, Division of Epidemiology, Box 4404, Nydalen, 0403 Oslo, Norway University of Oslo, Department of Community Medicine, Oslo, Norway
| | - Kristin Holvik
- Norwegian Institute of Public Health, Division of Epidemiology, Box 4404, Nydalen, 0403 Oslo, Norway
| | - Paul Lips
- Endocrine Section, Department of Internal Medicine, VU University Medical Centre, Amsterdam, Netherlands
| |
Collapse
|
50
|
Pfeifer M, Hinz C, Lazarescu AD, Minne HW. [Evaluation and socio-economic relevance of an integrated osteoporosis health care network]. Versicherungsmedizin 2014; 66:198-201. [PMID: 25558509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
During the last 6 to 7 years, integrated health care has become more and more important in Germany. In August 2005 we initiated a collaborative project involving two orthopaedic clinics in Hanover and one rehabilitation clinic in Bad Pyrmont specialising in the treatment of osteoporosis. Here, we report the results of 633 women (83 ± 7 years) and 162 men (75 ± 10 years) who participated in this programme between August 2005 and August 2012. All participants gave informed consent. All patients were supplemented with 1200 mg of calcium and 800 IU of vitamin D. Intravenous bisphosphonates were given to 91% and parathyroid hormone to 7% of the patients. Two per cent received miscellanous therapeutic agents. Follow-up visits were attended by 89% of the patients after one year and 78% after two years. During this time, a significant improvement was observed in vitamin D, parathyroid hormone and the bone marker desoxypyridinoline. DXA measurements were falsified by degenerative disease or fractures. In the men, however, a significant increase was observed in the total hip. Over the two-year period, 16 vertebral and 3 non-vertebral fractures occurred in the women. In the men, one non-vertebral and 5 vertebral fractures were noted. Among the women, 18 died and 6 were admitted to a nursing home. The corresponding figures among the men were 7 and 4, respectively. According to the figures provided by the central German institute for statistics, the death rates among the women were significantly lower than expected, whereas a tendency toward lower death rates was seen in the men. In addition, the number of new hip fractures in the women was lower than the epidemiological data suggest. This was also noted in the men. Even among the very old, a musculoskeletal rehabilitation programme combined with adequate pharmaceutical therapy may prove very successful when it comes to death rates and nursing home admissions. The latter in particular may be very expensive in the long run and our longitudinal follow-up study may demonstrate cost-effectiveness if the rehabilitation programme is commenced as early as possible.
Collapse
Affiliation(s)
- M Pfeifer
- Institut für Klinische Osteologie Gustav Pommer und der klinik DER FÜRSTENHOF, Bad Pyrmont
| | | | | | | |
Collapse
|