Cost-Effectiveness of Zoledronic Acid Versus Oral Alendronate for Postmenopausal Osteoporotic Women in China.

Ruxu You,Nan Luo,Xinyu Qian,David Bin-Chia Wu,Yu Zhang,Takahiro Mori,Jinyu Liu

doi:10.3389/fphar.2020.00456

Abstract

ObjectiveThis study aims to estimate the cost-effectiveness of yearly intravenous zoledronic acid treatment versus weekly oral alendronate for postmenopausal osteoporotic women in China.MethodsWe used a Markov microsimulation model to compare the cost-effectiveness of zoledronic acid with alendronate in Chinese postmenopausal osteoporotic women with no fracture history at various ages of therapy initiation from health care payer perspective.ResultsThe incremental cost-effectiveness ratios (ICERs) for the zoledronic acid versus alendronate were $23,581/QALY at age 65 years, $17,367/QALY at age 70 years, $14,714/QALY at age 75 years, and $12,169/QALY at age 80 years, respectively. In deterministic sensitivity analyses, the study demonstrated that the two most impactful parameters were the annual cost of zoledronic acid and the relative risk of hip fracture with zoledronic acid. In probabilistic sensitivity analyses, the probabilities of zoledronic acid being cost-effective compared with alendronate were 70–100% at a willingness-to-pay of $29,340 per QALY.ConclusionsAmong postmenopausal osteoporotic women in China, zoledronic acid therapy is cost-effective at all ages examined from health care payer perspective, compared with weekly oral alendronate. In addition, alendronate treatment is shown to be dominant for patients at ages 65 and 70 with full persistence. This study will help clinicians and policymakers make better decisions about the relative economic value of osteoporosis treatments in China.

Highlights

Osteoporosis, characterized by bone mass reduction and microarchitectural deterioration of bone issue, has become a global public health concern worldwide (Cosman et al, 2014)
This number is elevated for individuals of both genders above 50 years of age (34.65%), with postmenopausal osteoporosis being the most significant contributor (Tella and Gallagher, 2014; Chen P. et al, 2016)
The incremental costeffectiveness ratios (ICERs) for the zoledronic acid versus alendronate were per qualityadjusted life-years (QALYs): $23,581 at age 65 years, $17,367 at age 70 years, $14,714 at age 75 years, and $12,169 at age 80 years, respectively

Summary

Introduction

Osteoporosis, characterized by bone mass reduction and microarchitectural deterioration of bone issue, has become a global public health concern worldwide (Cosman et al, 2014). Prevalence of osteoporosis in China has significantly increased over the past decade, from 14.94% before 2008 to 27.96% between 2012 and 2015 (Chen P. et al, 2016). This number is elevated for individuals of both genders above 50 years of age (34.65%), with postmenopausal osteoporosis being the most significant contributor (Tella and Gallagher, 2014; Chen P. et al, 2016). Postmenopausal osteoporotic can lead to hip, spine, wrist, and other fractures. These fractures significantly affect quality of life, work ability, and daily activities, and increase financial burden through higher healthcare expenditure. Around 2.3 million osteoporotic fractures occurred in China in 2010 among people aged ≥ 50 years, costing US$9.5 billion; both the number and costs of osteoporosis-related fractures are estimated to double by 2035, reaching 6 million fractures costing US$25.4 billion by 2050 (Si et al, 2015; Liu et al, 2018)

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