Markov Models for Economic Evaluation in Osteoporosis Treatment

Marta Osca-Guadalajara,David Vivas-Consuelo,Silvia González-De-Julián,Javier Díaz-Carnicero

doi:10.3390/math9182331

Marta Osca-Guadalajara, David Vivas-Consuelo + Show 2 more

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https://doi.org/10.3390/math9182331

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Journal: Mathematics	Publication Date: Sep 20, 2021
License type: CC BY 4.0

Affiliation: Universitat Politècnica de València

Abstract

Osteoporosis is frequent in elderly people, causing bone fractures and lowering their quality of life. The costs incurred by these fractures constitute a problem for public health. Markov chains were used to carry out an incremental cost-utility analysis of the four main drugs used in Spain to treat osteoporosis (alendronate, risedronate, denosumab and teriparatide). We considered 14 clinical transition states, from starting osteoporotic treatment at the age of 50 until death or the age of 100. Cost-effectiveness was measured by quality adjusted life years (QALYs). The values used in the Markov model were obtained from the literature. Teriparatide is the cost-effective alternative in the treatment of osteoporosis in patients with fractures from the age of 50, establishing a payment threshold of 20,000 EUR/QALY. However, it is the most expensive therapy, not appearing cost-effective in cases that do not present fracture and in ages over 80 years with fracture. Alendronate and denosumab therapies are presented as cost-effective osteoporosis treatment alternatives depending on the age of onset and duration of treatment. From the perspective of cost-effectiveness, establishing a payment threshold of 20,000 EUR/QALY, teriparatide is the cost-effective alternative in patients with fracture from the age of 50 to 70 years old in Spain.

Highlights

IntroductionOsteoporosis is a chronic disease, characterized by the loss of bone quality and mass
Osteoporosis is a chronic disease, characterized by the loss of bone quality and mass.Generally, there is no symptomatology until a fracture occurs
The results obtained in the cost-utility analysis are presented below for treatment starting at 50, 60, 70 and 80 years old with alendronate, risedronate and denosumab, and at the time of the fracture in the case of teriparatide

Summary

Introduction

Osteoporosis is a chronic disease, characterized by the loss of bone quality and mass. There is no symptomatology until a fracture occurs. In the age group of 50–84, approximately 6% of men and 21% of women suffer from osteoporosis [1]. The principle risk factors for the disease are age and being female, and it is calculated that 2% of 50year-old women suffer from it, rising to 25% at 80 [2]. Sustaining a fragility fracture is considered to be one of the most important factors in experiencing subsequent fractures [3,4]. It is estimated that there are 323 million people over 65 with the disease worldwide, and, given the increase in life-expectancy, this is expected to increase to up to 1.555 billion by 2050 [5], increasing the prevalence of fragility fractures.

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