Abstract
SummaryAmong hypothetical cohorts of older osteoporotic women without prior fragility fracture in Japan, we evaluated the cost-effectiveness of two treatment strategies using a simulation model. Annual intravenous zoledronic acid for 3 years was cost-saving compared with biannual subcutaneous denosumab for 3 years followed by weekly oral alendronate for 3 years.PurposeOsteoporosis constitutes a major medical and health economic burden to society worldwide. Injectable treatments for osteoporosis require less frequent administration than oral treatments and therefore have higher persistence and adherence with treatment, which could explain better efficacy for fracture prevention. Although annual intravenous zoledronic acid and biannual subcutaneous denosumab are available, it remains unclear which treatment strategy represents a better value from a health economic perspective. Accordingly, we examined the cost-effectiveness of zoledronic acid for 3 years compared with sequential denosumab/alendronate (i.e., denosumab for 3 years followed by oral weekly alendronate for 3 years, making the total treatment duration 6 years) among hypothetical cohorts of community-dwelling osteoporotic women without prior fragility fracture in Japan at ages 65, 70, 75, or 80 years.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 public healthcare and long-term care payer’s perspective over a lifetime horizon with a willingness-to-pay of ¥5 million (or $47,500) per QALY.ResultsIn the base case, zoledronic acid was cost-saving (i.e., more effective and less expensive) compared with sequential denosumab/alendronate. In deterministic sensitivity analyses, results were sensitive to changes in the efficacy of zoledronic acid or the cumulative persistence rate with zoledronic acid or denosumab. In probabilistic sensitivity analyses, the probabilities of zoledronic acid being cost-effective were 98–100%.ConclusionsAmong older osteoporotic women without prior fragility fracture in Japan, zoledronic acid was cost-saving compared with sequential denosumab/alendronate.
Highlights
Osteoporosis constitutes a major burden to society worldwide, and pharmacologic therapy to prevent fractures is the mainstay of treatment
This was the case in our previous health economic evaluation, which compared subcutaneous denosumab given every 6 months with oral alendronate given weekly [2]
In hypothetical cohorts of older women with osteoporosis without prior hip or vertebral fracture in Japan, we found that denosumab was cost-effective (i.e., more effective but more expensive, and the incremental cost-effectiveness ratio (ICER) is less than the predetermined threshold of willingness-to-pay) or cost-saving mainly due to denosumab’s higher persistence rate leading to better efficacy for fracture prevention compared with oral alendronate
Summary
Osteoporosis constitutes a major burden to society worldwide, and pharmacologic therapy to prevent fractures is the mainstay of treatment. Persistence and adherence are more favorable with injectable medications and could explain better efficacy for fracture prevention. This better persistence and adherence associated with less frequent administration may offset the higher cost per dose for injectable medications. This was the case in our previous health economic evaluation, which compared subcutaneous denosumab given every 6 months (the least frequent dose of a medication available for the treatment of osteoporosis in Japan at the time of the analysis) with oral alendronate given weekly [2]. In hypothetical cohorts of older women with osteoporosis without prior hip or vertebral fracture in Japan, we found that denosumab was cost-effective (i.e., more effective but more expensive, and the incremental cost-effectiveness ratio (ICER) is less than the predetermined threshold of willingness-to-pay) or cost-saving (i.e., more effective and less expensive) mainly due to denosumab’s higher persistence rate leading to better efficacy for fracture prevention compared with oral alendronate
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