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Cost-effectiveness of denosumab in the treatment of postmenopausal osteoporosis in Canada.
J Med Econ. 2012; 15 Suppl 1:3-14.JM

Abstract

OBJECTIVE

Denosumab is a novel biologic agent approved in Canada for treatment of post-menopausal osteoporosis (PMO) in women at high risk for fracture or who have failed or are intolerant to other osteoporosis therapies. This study estimated cost-effectiveness of denosumab vs usual care from the perspective of the Ontario public payer.

METHODS

A previously published PMO Markov cohort model was adapted for Canada to estimate cost-effectiveness of denosumab. The primary analysis included women with demographic characteristics similar to those from the pivotal phase III denosumab PMO trial (FREEDOM; age 72 years, femoral neck BMD T-score -2.16 SD, vertebral fracture prevalence 23.6%). Three additional scenario sub-groups were examined including women: (1) at high fracture risk, defined in FREEDOM as having at least two of three risk factors (age 70+; T-score ≤ -3.0 SD at lumbar spine, total hip, or femoral neck; prevalent vertebral fracture); (2) age 75+; and (3) intolerant or contraindicated to oral bisphosphonates (BPs). Analyses were conducted over a lifetime horizon comparing denosumab to usual care ('no therapy', alendronate, risedronate, or raloxifene [sub-group 3 only]). The analysis considered treatment-specific persistence and post-discontinuation residual efficacy, as well as treatment-specific adverse events. Both deterministic and probabilistic sensitivity analyses were conducted.

RESULTS

The multi-therapy comparisons resulted in incremental cost-effectiveness ratios for denosumab vs alendronate of $60,266 (2010 CDN$) (primary analysis) and $27,287 per quality-adjusted life year gained for scenario sub-group 1. Denosumab dominated all therapies in the remaining scenarios.

LIMITATIONS

Key limitations include a lack of long-term, real-world, Canadian data on persistence with denosumab as well as an absence of head-to-head clinical data, leaving one to rely on meta-analyses based on trials comparing treatment to placebo.

CONCLUSIONS

Denosumab may be cost-effective compared to oral PMO treatments for women at high risk of fractures and those who are intolerant and/or contraindicated to oral BPs.

Authors+Show Affiliations

Amgen Canada Inc, Mississauga, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23035625

Citation

Chau, D, et al. "Cost-effectiveness of Denosumab in the Treatment of Postmenopausal Osteoporosis in Canada." Journal of Medical Economics, vol. 15 Suppl 1, 2012, pp. 3-14.
Chau D, Becker DL, Coombes ME, et al. Cost-effectiveness of denosumab in the treatment of postmenopausal osteoporosis in Canada. J Med Econ. 2012;15 Suppl 1:3-14.
Chau, D., Becker, D. L., Coombes, M. E., Ioannidis, G., Adachi, J. D., & Goeree, R. (2012). Cost-effectiveness of denosumab in the treatment of postmenopausal osteoporosis in Canada. Journal of Medical Economics, 15 Suppl 1, 3-14. https://doi.org/10.3111/13696998.2012.737393
Chau D, et al. Cost-effectiveness of Denosumab in the Treatment of Postmenopausal Osteoporosis in Canada. J Med Econ. 2012;15 Suppl 1:3-14. PubMed PMID: 23035625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of denosumab in the treatment of postmenopausal osteoporosis in Canada. AU - Chau,D, AU - Becker,D L, AU - Coombes,M E, AU - Ioannidis,G, AU - Adachi,J D, AU - Goeree,R, Y1 - 2012/10/16/ PY - 2012/10/6/entrez PY - 2012/10/6/pubmed PY - 2013/5/11/medline SP - 3 EP - 14 JF - Journal of medical economics JO - J Med Econ VL - 15 Suppl 1 N2 - OBJECTIVE: Denosumab is a novel biologic agent approved in Canada for treatment of post-menopausal osteoporosis (PMO) in women at high risk for fracture or who have failed or are intolerant to other osteoporosis therapies. This study estimated cost-effectiveness of denosumab vs usual care from the perspective of the Ontario public payer. METHODS: A previously published PMO Markov cohort model was adapted for Canada to estimate cost-effectiveness of denosumab. The primary analysis included women with demographic characteristics similar to those from the pivotal phase III denosumab PMO trial (FREEDOM; age 72 years, femoral neck BMD T-score -2.16 SD, vertebral fracture prevalence 23.6%). Three additional scenario sub-groups were examined including women: (1) at high fracture risk, defined in FREEDOM as having at least two of three risk factors (age 70+; T-score ≤ -3.0 SD at lumbar spine, total hip, or femoral neck; prevalent vertebral fracture); (2) age 75+; and (3) intolerant or contraindicated to oral bisphosphonates (BPs). Analyses were conducted over a lifetime horizon comparing denosumab to usual care ('no therapy', alendronate, risedronate, or raloxifene [sub-group 3 only]). The analysis considered treatment-specific persistence and post-discontinuation residual efficacy, as well as treatment-specific adverse events. Both deterministic and probabilistic sensitivity analyses were conducted. RESULTS: The multi-therapy comparisons resulted in incremental cost-effectiveness ratios for denosumab vs alendronate of $60,266 (2010 CDN$) (primary analysis) and $27,287 per quality-adjusted life year gained for scenario sub-group 1. Denosumab dominated all therapies in the remaining scenarios. LIMITATIONS: Key limitations include a lack of long-term, real-world, Canadian data on persistence with denosumab as well as an absence of head-to-head clinical data, leaving one to rely on meta-analyses based on trials comparing treatment to placebo. CONCLUSIONS: Denosumab may be cost-effective compared to oral PMO treatments for women at high risk of fractures and those who are intolerant and/or contraindicated to oral BPs. SN - 1941-837X UR - https://www.unboundmedicine.com/medline/citation/23035625/Cost_effectiveness_of_denosumab_in_the_treatment_of_postmenopausal_osteoporosis_in_Canada_ L2 - https://www.tandfonline.com/doi/full/10.3111/13696998.2012.737393 DB - PRIME DP - Unbound Medicine ER -