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Cost-effectiveness of sequential treatment with abaloparatide followed by alendronate vs. alendronate monotherapy in women at increased risk of fracture: A US payer perspective.
Semin Arthritis Rheum. 2020 06; 50(3):394-400.SA

Abstract

OBJECTIVES

Emerging evidence supports sequential therapy with anabolic followed by 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 to ALN monotherapy and to sequential treatment starting with antiresorptive therapy (ALN/ABL/ALN).

METHODS

A previously validated Markov microsimulation model was used to estimate the cost-effectiveness of sequential ABL/ALN compared to ALN monotherapy and to sequential ALN/ABL/ALN from a lifetime US payer perspective. In line with practice guidelines, patients were assumed to receive ABL for 18 months followed by 5 years of ALN, or ALN monotherapy for 5 years, or a sequence of ALN for 2 years followed by 18 months of ABL and then by 3 years ALN. Evaluation was conducted for patients aged 50-80 years old with a BMD T-score ≤-3.5 and without a history of prior fracture, or with a T-score between -2.5 and -3.5 and a history of ≥ 1 osteoporotic fracture.

RESULTS

Sequential ABL/ALN was cost-effective (threshold of US$150,000 per QALY) vs generic ALN monotherapy in women ≥60 years with a BMD T-score ≤-3.5 and in women with BMD T-score between -2.5 and -3.5 and history of osteoporotic fracture. In all simulated populations, sequential ABL/ALN therapy was dominant (lower costs, more QALYs) compared with sequential ALN/ABL/ALN, resulting from limited effect of ABL in patients previously treated with an antiresorptive agent.

CONCLUSIONS

Sequential ABL/ALN therapy is cost-effective vs ALN monotherapy for US postmenopausal women aged ≥60 years at increased risk of fractures.

Authors+Show Affiliations

Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, 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.Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, KSA, Saudi Arabia.

Pub Type(s)

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

Language

eng

PubMed ID

32160943

Citation

Hiligsmann, Mickael, et al. "Cost-effectiveness of Sequential Treatment With Abaloparatide Followed By Alendronate Vs. Alendronate Monotherapy in Women at Increased Risk of Fracture: a US Payer Perspective." Seminars in Arthritis and Rheumatism, vol. 50, no. 3, 2020, pp. 394-400.
Hiligsmann M, Williams SA, Fitzpatrick LA, et al. Cost-effectiveness of sequential treatment with abaloparatide followed by alendronate vs. alendronate monotherapy in women at increased risk of fracture: A US payer perspective. Semin Arthritis Rheum. 2020;50(3):394-400.
Hiligsmann, M., Williams, S. A., Fitzpatrick, L. A., Silverman, S. S., Weiss, R., & Reginster, J. Y. (2020). Cost-effectiveness of sequential treatment with abaloparatide followed by alendronate vs. alendronate monotherapy in women at increased risk of fracture: A US payer perspective. Seminars in Arthritis and Rheumatism, 50(3), 394-400. https://doi.org/10.1016/j.semarthrit.2020.02.004
Hiligsmann M, et al. Cost-effectiveness of Sequential Treatment With Abaloparatide Followed By Alendronate Vs. Alendronate Monotherapy in Women at Increased Risk of Fracture: a US Payer Perspective. Semin Arthritis Rheum. 2020;50(3):394-400. PubMed PMID: 32160943.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of sequential treatment with abaloparatide followed by alendronate vs. alendronate monotherapy in women at increased risk of fracture: A US payer perspective. AU - Hiligsmann,Mickael, AU - Williams,Setareh A, AU - Fitzpatrick,Lorraine A, AU - Silverman,Stuart S, AU - Weiss,Richard, AU - Reginster,Jean-Yves, Y1 - 2020/02/13/ PY - 2019/09/17/received PY - 2019/12/06/revised PY - 2020/02/08/accepted PY - 2020/3/13/pubmed PY - 2021/4/28/medline PY - 2020/3/13/entrez KW - Abaloparatide KW - Alendronate KW - Economic evaluation KW - Monotherapy KW - Osteoporosis KW - Sequential treatmen SP - 394 EP - 400 JF - Seminars in arthritis and rheumatism JO - Semin Arthritis Rheum VL - 50 IS - 3 N2 - OBJECTIVES: Emerging evidence supports sequential therapy with anabolic followed by 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 to ALN monotherapy and to sequential treatment starting with antiresorptive therapy (ALN/ABL/ALN). METHODS: A previously validated Markov microsimulation model was used to estimate the cost-effectiveness of sequential ABL/ALN compared to ALN monotherapy and to sequential ALN/ABL/ALN from a lifetime US payer perspective. In line with practice guidelines, patients were assumed to receive ABL for 18 months followed by 5 years of ALN, or ALN monotherapy for 5 years, or a sequence of ALN for 2 years followed by 18 months of ABL and then by 3 years ALN. Evaluation was conducted for patients aged 50-80 years old with a BMD T-score ≤-3.5 and without a history of prior fracture, or with a T-score between -2.5 and -3.5 and a history of ≥ 1 osteoporotic fracture. RESULTS: Sequential ABL/ALN was cost-effective (threshold of US$150,000 per QALY) vs generic ALN monotherapy in women ≥60 years with a BMD T-score ≤-3.5 and in women with BMD T-score between -2.5 and -3.5 and history of osteoporotic fracture. In all simulated populations, sequential ABL/ALN therapy was dominant (lower costs, more QALYs) compared with sequential ALN/ABL/ALN, resulting from limited effect of ABL in patients previously treated with an antiresorptive agent. CONCLUSIONS: Sequential ABL/ALN therapy is cost-effective vs ALN monotherapy for US postmenopausal women aged ≥60 years at increased risk of fractures. SN - 1532-866X UR - https://www.unboundmedicine.com/medline/citation/32160943/Cost_effectiveness_of_sequential_treatment_with_abaloparatide_followed_by_alendronate_vs__alendronate_monotherapy_in_women_at_increased_risk_of_fracture:_A_US_payer_perspective_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-0172(20)30023-8 DB - PRIME DP - Unbound Medicine ER -