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Cost-effectiveness of sequential treatment with abaloparatide vs. teriparatide for United States women at increased risk of fracture.
Semin Arthritis Rheum. 2019 10; 49(2):184-196.SA

Abstract

OBJECTIVES

There is emerging evidence supporting sequential therapy with an osteoanabolic followed by an antiresorptive in patients at high-risk of fragility fractures. This study assessed the cost-effectiveness of sequential treatment with abaloparatide (ABL) followed by alendronate (ALN) [(ABL/ALN)] compared with teriparatide (TPTD) followed by ALN (TPTD/ALN).

METHODS

A previously validated Markov microsimulation model was adapted to estimate the cost-effectiveness of sequential ABL/ALN compared with sequential TPTD/ALN and no treatment with a lifetime horizon from the US payer perspective. Patients were assumed to receive ABL or TPTD for 18 months followed by 5 years of ALN in line with clinical recommendations. The effects of ABL on fracture risk were derived from the ACTIVExtend trial. The effects of TPTD were assumed to be maintained during subsequent ALN treatment, consistent with ACTIVExtend findings for ABL. Evaluation was completed for patients, aged 50-80 years with a BMD T-score ≤ -3.5 or with a T-score between -2.5 and -3.5 and a history of ≥ one osteoporotic fracture.

RESULTS

In all simulated populations, sequential ABL/ALN therapy was dominant (lower costs, higher QALYs) compared with sequential TPTD/ALN therapy, resulting from the improved efficacy and lower drug price of ABL. Probabilistic sensitivity analyses suggested that ABL/ALN was dominant in at least 99% of the simulations. Compared to no treatment, the cost per QALY gained of ABL/ALN was always below $130,000.

CONCLUSIONS

Sequential ABL/ALN therapy is a cost-effective (dominant) strategy compared with sequential TPTD/ALN therapy for the treatment of US women at increased risk of fractures.

Authors+Show Affiliations

Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht 6200 MD, the Netherlands. Electronic address: m.hiligsmann@maastrichtuniversity.nl.Radius Health, Inc., Waltham, MA, United States.Radius Health, Inc., Waltham, MA, United States.Cedar-Sinai Medical Center and UCLA School of Medicine, Los Angeles, CA, United States.Radius Health, Inc., Waltham, MA, United States.Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.

Pub Type(s)

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

Language

eng

PubMed ID

30737062

Citation

Hiligsmann, Mickael, et al. "Cost-effectiveness of Sequential Treatment With Abaloparatide Vs. Teriparatide for United States Women at Increased Risk of Fracture." Seminars in Arthritis and Rheumatism, vol. 49, no. 2, 2019, pp. 184-196.
Hiligsmann M, Williams SA, Fitzpatrick LA, et al. Cost-effectiveness of sequential treatment with abaloparatide vs. teriparatide for United States women at increased risk of fracture. Semin Arthritis Rheum. 2019;49(2):184-196.
Hiligsmann, M., Williams, S. A., Fitzpatrick, L. A., Silverman, S. S., Weiss, R., & Reginster, J. Y. (2019). Cost-effectiveness of sequential treatment with abaloparatide vs. teriparatide for United States women at increased risk of fracture. Seminars in Arthritis and Rheumatism, 49(2), 184-196. https://doi.org/10.1016/j.semarthrit.2019.01.006
Hiligsmann M, et al. Cost-effectiveness of Sequential Treatment With Abaloparatide Vs. Teriparatide for United States Women at Increased Risk of Fracture. Semin Arthritis Rheum. 2019;49(2):184-196. PubMed PMID: 30737062.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of sequential treatment with abaloparatide vs. teriparatide for United States women at increased risk of fracture. AU - Hiligsmann,Mickael, AU - Williams,Setareh A, AU - Fitzpatrick,Lorraine A, AU - Silverman,Stuart S, AU - Weiss,Richard, AU - Reginster,Jean-Yves, Y1 - 2019/01/10/ PY - 2018/09/06/received PY - 2018/12/20/revised PY - 2019/01/08/accepted PY - 2019/2/10/pubmed PY - 2020/7/1/medline PY - 2019/2/10/entrez KW - Abaloparatide KW - Economic evaluation KW - Osteoporosis KW - Teriparatide SP - 184 EP - 196 JF - Seminars in arthritis and rheumatism JO - Semin Arthritis Rheum VL - 49 IS - 2 N2 - OBJECTIVES: There is emerging evidence supporting sequential therapy with an osteoanabolic followed by an antiresorptive in patients at high-risk of fragility fractures. This study assessed the cost-effectiveness of sequential treatment with abaloparatide (ABL) followed by alendronate (ALN) [(ABL/ALN)] compared with teriparatide (TPTD) followed by ALN (TPTD/ALN). METHODS: A previously validated Markov microsimulation model was adapted to estimate the cost-effectiveness of sequential ABL/ALN compared with sequential TPTD/ALN and no treatment with a lifetime horizon from the US payer perspective. Patients were assumed to receive ABL or TPTD for 18 months followed by 5 years of ALN in line with clinical recommendations. The effects of ABL on fracture risk were derived from the ACTIVExtend trial. The effects of TPTD were assumed to be maintained during subsequent ALN treatment, consistent with ACTIVExtend findings for ABL. Evaluation was completed for patients, aged 50-80 years with a BMD T-score ≤ -3.5 or with a T-score between -2.5 and -3.5 and a history of ≥ one osteoporotic fracture. RESULTS: In all simulated populations, sequential ABL/ALN therapy was dominant (lower costs, higher QALYs) compared with sequential TPTD/ALN therapy, resulting from the improved efficacy and lower drug price of ABL. Probabilistic sensitivity analyses suggested that ABL/ALN was dominant in at least 99% of the simulations. Compared to no treatment, the cost per QALY gained of ABL/ALN was always below $130,000. CONCLUSIONS: Sequential ABL/ALN therapy is a cost-effective (dominant) strategy compared with sequential TPTD/ALN therapy for the treatment of US women at increased risk of fractures. SN - 1532-866X UR - https://www.unboundmedicine.com/medline/citation/30737062/Cost_effectiveness_of_sequential_treatment_with_abaloparatide_vs__teriparatide_for_United_States_women_at_increased_risk_of_fracture_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-0172(18)30562-6 DB - PRIME DP - Unbound Medicine ER -