Abstract
SummaryUsing a Markov microsimulation model among hypothetical cohorts of community-dwelling older osteoporotic Japanese women with prior vertebral fracture over a lifetime horizon, we found that daily subcutaneous teriparatide for 2 years followed by weekly oral alendronate for 8 years was not cost-effective compared with alendronate monotherapy for 10 years.PurposeTeriparatide has proven efficacy in reducing osteoporotic fractures, but with substantial cost. We examined the cost-effectiveness of sequential teriparatide/alendronate (i.e., daily subcutaneous teriparatide for 2 years followed by weekly oral alendronate for 8 years) compared with alendronate monotherapy for 10 years among community-dwelling older osteoporotic women with prior clinical or morphometric vertebral fracture in Japan.MethodsUsing a previously validated and updated Markov microsimulation model, we obtained incremental cost-effectiveness ratios (Japanese yen [¥] (or US dollars [$]) per quality-adjusted life year [QALY]) from the perspective of a single payer responsible for both public healthcare and long-term care. We assumed a lifetime horizon with a willingness-to-pay of ¥5million (or $47,500) per QALY in the base case. We modeled the cost of biosimilar teriparatide, which has been available since November 2019 in Japan, assuming the efficacy was the same as that of the brand version.ResultsIn the base case, sequential teriparatide/alendronate was not cost-effective compared with alendronate monotherapy. In deterministic sensitivity analyses, sequential teriparatide/alendronate would become cost-effective with 85%, 50%, and 15% price discounts to teriparatide at ages 70, 75, and 80, respectively, compared to the current biosimilar cost. Otherwise, results were especially sensitive to changes that affected efficacy of teriparatide or alendronate. In probabilistic sensitivity analyses, the probabilities of sequential teriparatide/alendronate being cost-effective were 0%, 1%, and 37% at ages 70, 75, and 80, respectively.ConclusionsAmong high-risk osteoporotic women in Japan, sequential teriparatide/alendronate was not cost-effective compared with alendronate monotherapy, even with the availability of biosimilar teriparatide.
Highlights
Osteoporosis leads to fragility fractures and constitutes a major medical and public health concern worldwide
As a typical scenario for teriparatide’s use, we compared the cost-effectiveness of sequential teriparatide/alendronate, which in this study was defined as daily subcutaneous teriparatide for 2 years followed by weekly oral alendronate for 8 years, compared with weekly oral alendronate monotherapy for 10 years among women with prior clinical or morphometric vertebral fracture in Japan
We compared the cost-effectiveness of sequential teriparatide/ alendronate, compared with weekly oral alendronate monotherapy for 10 years
Summary
Osteoporosis leads to fragility fractures and constitutes a major medical and public health concern worldwide. Compared with Caucasians, the Japanese population has been reported to have higher annual incidence rates of clinical vertebral fracture and lower rates of hip fracture [2, 3]. This makes a strategy to reduce the risk of vertebral fracture important in the Japanese population, especially in those at high risk for vertebral fracture, such as those with a prior history of vertebral fracture [4]. The current Japanese guidelines for the prevention and treatment of osteoporosis conclude that there is high-quality evidence for teriparatide increasing bone mineral density and reducing the risk of vertebral fracture. The guidelines recommend that teriparatide generally should not be used as a first-line drug for the treatment of osteoporosis, but could be considered a treatment of choice for those at high risk for osteoporotic fracture [5]
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