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Denosumab: a cost-effective alternative for older men with osteoporosis from a Swedish payer perspective.
Bone. 2014 Feb; 59:105-13.BONE

Abstract

OBJECTIVE

To assess the cost-effectiveness of denosumab versus other treatments in men with osteoporosis who are ≥75years old from a payer perspective in Sweden.

METHODS

A lifetime cohort Markov model was developed with seven health states: well, hip fracture, vertebral fracture, other osteoporotic fracture, post-hip fracture, post-vertebral fracture, and dead. 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. Estimates of fracture efficacy were drawn from available studies in post-menopausal osteoporotic (PMO) women as BMD improvements have been shown to be similar across male osteoporosis (MOP) and PMO populations, and a recent clinical trial suggested that the fracture risk reduction from bisphosphonate therapy in men is similar to that seen in women in comparable studies. Lifetime expected costs and quality-adjusted life-years (QALYs) were estimated for denosumab, generic alendronate, generic risedronate, ibandronate, zoledronate, strontium ranelate and teriparatide. On average, patients in the model were 78years old, with bone mineral density T-score at the femoral neck of -2.12. Prevalent vertebral fractures were present in 23% of patients. In the base-case, the model assumed that patients would experience treatment-related effects up to 2years after discontinuation. Costs and QALYs were discounted at 3% annually. Extensive sensitivity analyses were conducted.

RESULTS

Total lifetime costs for denosumab, alendronate, strontium ranelate, zoledronate, risedronate, ibandronate and teriparatide were €31,004, €33,731, €34,788, €34,796, €34,826, €35,983 and €37,461, respectively. Total QALYs were 5.23, 5.15, 5.15, 5.17, 5.13, 5.12 and 5.22, respectively. Compared to other treatments, denosumab had the lowest costs and highest QALYs. In the one-way sensitivity analyses, when compared to alendronate (next least expensive strategy), the ICER for denosumab was most sensitive to the relative risk of hip fracture on denosumab. The probability of denosumab being cost-effective compared to the other treatments at a threshold of €66,000/QALY was 96.1%.

CONCLUSION

Denosumab dominated all comparators, including generic bisphosphonates, in the treatment of osteoporosis in men who were ≥75years old in Sweden.

Authors+Show Affiliations

OptumInsight, One Main Street, Cambridge, MA 02142, USA. Electronic address: anju.parthan@optum.com.OptumInsight, One Main Street, Cambridge, MA 02142, USA. Electronic address: morgan.kruse@optum.com.Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA 91320, USA. Electronic address: iagodoa@amgen.com.Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA. Electronic address: stuarts@slsdss.net.Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L607, Portland, OR 97239, USA. Electronic address: orwoll@ohsu.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24231131

Citation

Parthan, A, et al. "Denosumab: a Cost-effective Alternative for Older Men With Osteoporosis From a Swedish Payer Perspective." Bone, vol. 59, 2014, pp. 105-13.
Parthan A, Kruse M, Agodoa I, et al. Denosumab: a cost-effective alternative for older men with osteoporosis from a Swedish payer perspective. Bone. 2014;59:105-13.
Parthan, A., Kruse, M., Agodoa, I., Silverman, S., & Orwoll, E. (2014). Denosumab: a cost-effective alternative for older men with osteoporosis from a Swedish payer perspective. Bone, 59, 105-13. https://doi.org/10.1016/j.bone.2013.11.002
Parthan A, et al. Denosumab: a Cost-effective Alternative for Older Men With Osteoporosis From a Swedish Payer Perspective. Bone. 2014;59:105-13. PubMed PMID: 24231131.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Denosumab: a cost-effective alternative for older men with osteoporosis from a Swedish payer perspective. AU - Parthan,A, AU - Kruse,M, AU - Agodoa,I, AU - Silverman,S, AU - Orwoll,E, Y1 - 2013/11/12/ PY - 2013/03/14/received PY - 2013/10/30/revised PY - 2013/11/01/accepted PY - 2013/11/16/entrez PY - 2013/11/16/pubmed PY - 2014/9/10/medline KW - A multicenter, randomized, double-blind, placebo-controlled study to compare the efficacy and safety of DenosumAb 60mg every six months versus placebo in Males with Osteoporosis KW - ADAMO KW - BMD KW - Bone mineral density KW - Cost-effectiveness KW - DAPS KW - Denosumab KW - Denosumab Adherence Preference Satisfaction KW - EMA KW - EQ-5D KW - EuroQOL-5 Dimension KW - European Medical Agency KW - FIT KW - FREEDOM KW - Fracture KW - Fracture Intervention Trial KW - Fracture REduction Evaluation of Denosumab in Osteoporosis Every 6Months KW - HALT KW - Hormone Ablation Bone Loss Trial KW - ICER KW - IV KW - Incremental cost-effectiveness ratio KW - Intravenous KW - LTC KW - LY KW - Life-year KW - Long-term care institution KW - MOP KW - Male osteoporosis KW - NICE KW - National Institute for Health and Care Excellence KW - PMO KW - PSA KW - Post-menopausal osteoporosis KW - Probabilistic sensitivity analysis KW - QALY KW - Quality-adjusted life-year KW - Sweden SP - 105 EP - 13 JF - Bone JO - Bone VL - 59 N2 - OBJECTIVE: To assess the cost-effectiveness of denosumab versus other treatments in men with osteoporosis who are ≥75years old from a payer perspective in Sweden. METHODS: A lifetime cohort Markov model was developed with seven health states: well, hip fracture, vertebral fracture, other osteoporotic fracture, post-hip fracture, post-vertebral fracture, and dead. 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. Estimates of fracture efficacy were drawn from available studies in post-menopausal osteoporotic (PMO) women as BMD improvements have been shown to be similar across male osteoporosis (MOP) and PMO populations, and a recent clinical trial suggested that the fracture risk reduction from bisphosphonate therapy in men is similar to that seen in women in comparable studies. Lifetime expected costs and quality-adjusted life-years (QALYs) were estimated for denosumab, generic alendronate, generic risedronate, ibandronate, zoledronate, strontium ranelate and teriparatide. On average, patients in the model were 78years old, with bone mineral density T-score at the femoral neck of -2.12. Prevalent vertebral fractures were present in 23% of patients. In the base-case, the model assumed that patients would experience treatment-related effects up to 2years after discontinuation. Costs and QALYs were discounted at 3% annually. Extensive sensitivity analyses were conducted. RESULTS: Total lifetime costs for denosumab, alendronate, strontium ranelate, zoledronate, risedronate, ibandronate and teriparatide were €31,004, €33,731, €34,788, €34,796, €34,826, €35,983 and €37,461, respectively. Total QALYs were 5.23, 5.15, 5.15, 5.17, 5.13, 5.12 and 5.22, respectively. Compared to other treatments, denosumab had the lowest costs and highest QALYs. In the one-way sensitivity analyses, when compared to alendronate (next least expensive strategy), the ICER for denosumab was most sensitive to the relative risk of hip fracture on denosumab. The probability of denosumab being cost-effective compared to the other treatments at a threshold of €66,000/QALY was 96.1%. CONCLUSION: Denosumab dominated all comparators, including generic bisphosphonates, in the treatment of osteoporosis in men who were ≥75years old in Sweden. SN - 1873-2763 UR - https://www.unboundmedicine.com/medline/citation/24231131/Denosumab:_a_cost_effective_alternative_for_older_men_with_osteoporosis_from_a_Swedish_payer_perspective_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S8756-3282(13)00438-9 DB - PRIME DP - Unbound Medicine ER -