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A Model for Assessing the Clinical and Economic Benefits of Bone-forming Agents for Reducing Fractures in Postmenopausal Women at High, Near-term Risk of Osteoporotic Fracture.
Clin Ther. 2017 Jul; 39(7):1276-1290.CT

Abstract

PURPOSE

The goal of this study was to assess and compare the potential clinical and economic value of emerging bone-forming agents using the only currently available agent, teriparatide, as a reference case in patients at high, near-term (imminent, 1- to 2-year) risk of osteoporotic fractures, extending to a lifetime horizon with sequenced antiresorptive agents for maintenance treatment.

METHODS

Analyses were performed by using a Markov cohort model accounting for time-specific fracture protection effects of bone-forming agents followed by antiresorptive treatment with denosumab. The alternative bone-forming agent profiles were defined by using assumptions regarding the onset and total magnitude of protection against fractures with teriparatide. The model cohort comprised 70-year-old female patients with T scores below -2.5 and a previous vertebral fracture. Outcomes included clinical fractures, direct costs, and quality-adjusted life years. The simulated treatment strategies were compared by calculating their incremental "value" (net monetary benefit).

FINDINGS

Improvements in the onset and magnitude of fracture protection (vs the teriparatide reference case) produced a net monetary benefit of $17,000,000 per 10,000 treated patients during the (1.5-year) bone-forming agent treatment period and $80,000,000 over a lifetime horizon that included 3.5 years of maintenance treatment with denosumab.

IMPLICATIONS

Incorporating time-specific fracture effects in the Markov cohort model allowed for estimation of a range of cost savings, quality-adjusted life years gained, and clinical fractures avoided at different levels of fracture protection onset and magnitude. Results provide a first estimate of the potential "value" new bone-forming agents (romosozumab and abaloparatide) may confer relative to teriparatide.

Authors+Show Affiliations

Pardee RAND Graduate School, Santa Monica, California; Amgen, Thousand Oaks, California.Optum, Cambridge, Massachusetts.Optum, Cambridge, Massachusetts.Optum, Burlington, Ontario, Canada.Amgen (Europe) GmbH, Zug, Switzerland.Amgen, Thousand Oaks, California.Amgen, Thousand Oaks, California.Amgen, Thousand Oaks, California.Amgen, Thousand Oaks, California. Electronic address: rbarron@amgen.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28629610

Citation

O'Hanlon, Claire E., et al. "A Model for Assessing the Clinical and Economic Benefits of Bone-forming Agents for Reducing Fractures in Postmenopausal Women at High, Near-term Risk of Osteoporotic Fracture." Clinical Therapeutics, vol. 39, no. 7, 2017, pp. 1276-1290.
O'Hanlon CE, Parthan A, Kruse M, et al. A Model for Assessing the Clinical and Economic Benefits of Bone-forming Agents for Reducing Fractures in Postmenopausal Women at High, Near-term Risk of Osteoporotic Fracture. Clin Ther. 2017;39(7):1276-1290.
O'Hanlon, C. E., Parthan, A., Kruse, M., Cartier, S., Stollenwerk, B., Jiang, Y., Caloyeras, J. P., Crittenden, D. B., & Barron, R. (2017). A Model for Assessing the Clinical and Economic Benefits of Bone-forming Agents for Reducing Fractures in Postmenopausal Women at High, Near-term Risk of Osteoporotic Fracture. Clinical Therapeutics, 39(7), 1276-1290. https://doi.org/10.1016/j.clinthera.2017.05.348
O'Hanlon CE, et al. A Model for Assessing the Clinical and Economic Benefits of Bone-forming Agents for Reducing Fractures in Postmenopausal Women at High, Near-term Risk of Osteoporotic Fracture. Clin Ther. 2017;39(7):1276-1290. PubMed PMID: 28629610.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Model for Assessing the Clinical and Economic Benefits of Bone-forming Agents for Reducing Fractures in Postmenopausal Women at High, Near-term Risk of Osteoporotic Fracture. AU - O'Hanlon,Claire E, AU - Parthan,Anju, AU - Kruse,Morgan, AU - Cartier,Shannon, AU - Stollenwerk,Bjorn, AU - Jiang,Yawen, AU - Caloyeras,John P, AU - Crittenden,Daria B, AU - Barron,Richard, Y1 - 2017/06/17/ PY - 2017/03/13/received PY - 2017/05/18/revised PY - 2017/05/22/accepted PY - 2017/6/21/pubmed PY - 2017/12/27/medline PY - 2017/6/21/entrez KW - abaloparatide KW - bone fracture KW - bone-forming agents KW - cost-effectiveness KW - osteoporosis KW - romosozumab KW - teriparatide SP - 1276 EP - 1290 JF - Clinical therapeutics JO - Clin Ther VL - 39 IS - 7 N2 - PURPOSE: The goal of this study was to assess and compare the potential clinical and economic value of emerging bone-forming agents using the only currently available agent, teriparatide, as a reference case in patients at high, near-term (imminent, 1- to 2-year) risk of osteoporotic fractures, extending to a lifetime horizon with sequenced antiresorptive agents for maintenance treatment. METHODS: Analyses were performed by using a Markov cohort model accounting for time-specific fracture protection effects of bone-forming agents followed by antiresorptive treatment with denosumab. The alternative bone-forming agent profiles were defined by using assumptions regarding the onset and total magnitude of protection against fractures with teriparatide. The model cohort comprised 70-year-old female patients with T scores below -2.5 and a previous vertebral fracture. Outcomes included clinical fractures, direct costs, and quality-adjusted life years. The simulated treatment strategies were compared by calculating their incremental "value" (net monetary benefit). FINDINGS: Improvements in the onset and magnitude of fracture protection (vs the teriparatide reference case) produced a net monetary benefit of $17,000,000 per 10,000 treated patients during the (1.5-year) bone-forming agent treatment period and $80,000,000 over a lifetime horizon that included 3.5 years of maintenance treatment with denosumab. IMPLICATIONS: Incorporating time-specific fracture effects in the Markov cohort model allowed for estimation of a range of cost savings, quality-adjusted life years gained, and clinical fractures avoided at different levels of fracture protection onset and magnitude. Results provide a first estimate of the potential "value" new bone-forming agents (romosozumab and abaloparatide) may confer relative to teriparatide. SN - 1879-114X UR - https://www.unboundmedicine.com/medline/citation/28629610/A_Model_for_Assessing_the_Clinical_and_Economic_Benefits_of_Bone_forming_Agents_for_Reducing_Fractures_in_Postmenopausal_Women_at_High_Near_term_Risk_of_Osteoporotic_Fracture_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(17)30657-4 DB - PRIME DP - Unbound Medicine ER -