PMS30 - Is Denosumab Cost-Effective Compared To Oral Bisphosphonates For The Treatment Of Male Osteoporosis (Mop) In Sweden?

Abstract

PMS30 IS DENOSUMAB COST-EFFECTIVE COMPARED TO ORAL BISPHOSPHONATES FOR THE TREATMENT OF MALE OSTEOPOROSIS (MOP) IN SWEDEN? Parthan A1, Kruse MM1, Agodoa I2, Tao CY1, Silverman SL3, Orwoll E4 1OptumInsight, Cambridge, MA, USA, 2Amgen Inc., Thousand Oaks, CA, USA, 3CedarsSinai Hospital, Beverly Hills, CA, USA, 4Oregon Health & Science University, Portland, OR, USA OBJECTIVES: Cost-effectiveness of denosumab versus oral bisphosphonates in MOP was evaluated from a third-party payer perspective in Sweden. METHODS: A lifetime cohort Markov model was developed to reflect osteoporotic health states. During each cycle, patients could have a fracture, remain healthy, remain in a post fracture state or die. Background fracture risks, mortality rates, persistence rates, utilities, medical and drug costs were derived using published sources. Bone mineral density (BMD) improvements have been shown to be similar between MOP and post-menopausal osteoporotic (PMO) populations, and a recent fracture trial showed zoledronate to have effects in men similar to those reported previously in women; therefore efficacy data from PMO women were used. Lifetime expected costs and quality-adjusted life-years (QALYs) were estimated for denosumab, generic alendronate, generic risedronate, and ibandronate. Patients in the model were 65-year-old men, with BMD T-score≤1.90 and prevalent vertebral fracture of 22.7%. In the base-case, the model assumed patients could receive treatment effects up to 2 years after discontinuation (offset time). Costs and QALYs were discounted at 3% annually. Extensive sensitivity analyses were conducted. RESULTS: Total lifetime costs for alendronate, denosumab, risedronate, and ibandronate were €45,118, €45,396, €45,526, and €46,523, respectively. Total QALYs were 9.86, 9.91, 9.85, and 9.83, respectively. Denosumab had an incremental cost-effectiveness ratio (ICER) of €5,283 compared to alendronate and dominated risedronate and ibandronate. Results were most sensitive to changes in relative risk (RR) of hip fracture with denosumab, cost of denosumab and RR of vertebral fracture with denosumab. The probability of denosumab being cost-effective compared to oral bisphosphonates at a threshold of €66,000/QALY was 85.5%. In a sensitivity analysis of offset time of 5 years for oral bisphosphonates, denosumab had an ICER of €10,382 compared to alendronate. CONCLUSIONS: Denosumab is costeffective compared to branded and generic oral bisphosphonates in the Swedish MOP population.