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Applied Health Economics and Health Policy

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01-11-2011 | Review Article

A review of the cost effectiveness of bisphosphonates in the treatment of post-menopausal osteoporosis in Switzerland

Authors: Kurt Lippuner, Richard F. Pollock, Jayne Smith-Palmer, Thomas Meury, Dr William J. Valentine

Published in: Applied Health Economics and Health Policy | Issue 6/2011

Abstract

The economic burden associated with osteoporosis is considerable. As such, cost-effectiveness analyses are important contributors to the diagnostic and therapeutic decision-making process. The aim of this study was to review the cost effectiveness of treating post-menopausal osteoporosis with bisphosphonates and identify the key factors that influence the cost effectiveness of such treatment in the Swiss setting.

A systematic search of databases (MEDLINE, EMBASE and the Cochrane Library) was conducted to identify published literature on the cost effectiveness of bisphosphonates in post-menopausal osteoporosis in the Swiss setting. Outcomes were compared with similar studies in Western European countries.

Three cost-effectiveness studies of bisphosphonates in this patient population were identified; all were from a healthcare payer perspective. Outcomes showed that, relative to no treatment, treatment with oral bisphosphonates was predicted to be cost saving for most women aged ≥70 years with osteoporosis or at least one risk factor for fracture, and cost effective for women aged ≥75 years without prior fracture when used as a component of a population-based screen-and-treat programme. Results were most sensitive to changes in fracture risk, cost of fractures, cost of treatment, nursing home admissions and adherence with treatment. Swiss results were generally comparable to those in other European settings. Assuming similar clinical efficacy, lowering treatment cost (through the use of price-reduced brand-name or generic drugs) and/or improving adherence should both contribute to further improving the cost effectiveness of bisphosphonates in women with post-menopausal osteoporosis.

Published evidence indicates that bisphosphonates are estimated to be similarly cost effective or cost saving in most treatment scenarios of post-menopausal osteoporosis in Switzerland and in neighbouring European countries.

Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002; 359: 1761–7PubMedCrossRef

Robine JM, Paccaud F. Nonagenarians and centenarians in Switzerland, 1860–2001: a demographic analysis. J Epidemiol Community Health 2005; 59: 31–7PubMedCrossRef

Lippuner K, Golder M, Greiner R. Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int 2005; 16 Suppl. 2: S8–17CrossRef

Schwenkglenks M, Lippuner K, Hauselmann HJ, et al. A model of osteoporosis impact in Switzerland 2000–2020. Osteoporos Int 2005; 16: 659–71PubMedCrossRef

Suhm N, Lamy O, Lippuner K. Management of fragility fractures in Switzerland: results of a nationwide survey. Swiss Med Wkly 2008; 138: 674–83PubMed

Cranney A, Guyatt G, Griffith L, et al., Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis: IX. Summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev 2002; 23(4): 570–8PubMedCrossRef

Black DM, Delmas PD, Eastell R, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007; 356(18): 1809–22PubMedCrossRef

Stevenson M, Jones ML, De Nigris E, et al. A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. Health Technol Assess 2005; 9 (22): 1-160

Bock O, Felsenberg D. Bisphosphonates in the management of postmenopausal osteoporosis: optimizing efficacy in clinical practice. Clin Interv Aging 2008; 3: 279–97PubMed

10.

Kanis JA, Brazier JE, Stevenson M, et al. Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 2002; 6: 1–146PubMed

11.

Cosman F. Treatment of osteoporosis and prevention of new fractures: role of intravenously administered bisphosphonates. Endocr Pract 2009; 15: 483–93PubMedCrossRef

12.

Bischof M, Sendi P. How much bone for the buck? The importance of compliance issues in economic evaluations of bisphosphonates. Expert Rev Pharmacoecon Outcomes Res 2005; 5: 369–71PubMedCrossRef

13.

Viktoria SK, Dorner T, Lawrence K, et al. Economic concepts for measuring the costs of illness of osteoporosis: an international comparison. Wien Med Wochenschr 2009; 159: 253–61CrossRef

14.

Kanis JA, Johnell O, De Laet C, et al. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 2002; 17: 1237–44PubMedCrossRef

15.

Bouee S, Lafuma A, Fagnani F, et al. Estimation of direct unit costs associated with non-vertebral osteoporotic fractures in five European countries. Rheumatol Int 2006; 26: 1063–72PubMedCrossRef

16.

Fleurence RL, Iglesias CP, Torgerson DJ. Economic evaluations of interventions for the prevention and treatment of osteoporosis: a structured review of the literature. Osteoporos Int 2006; 17: 29–40PubMedCrossRef

17.

Zethraeus N, Borgstrom F, Strom O, et al. Cost-effectiveness of the treatment and prevention of osteoporosis: a review of the literature and a reference model. Osteoporos Int 2007; 18: 9–23PubMedCrossRef

18.

Organisation for Economic Co-operation and Development. OECD. Stat extracts [online]. Available from URL: http://stats.oecd.org/ [Accessed 2010 Mar 15]

19.

Wasserfallen JB, Krieg MA, Greiner RA, et al. Cost effectiveness and cost utility of risedronate for osteoporosis treatment and fracture prevention in women: a Swiss perspective. J Med Econ 2008; 11: 499–523PubMedCrossRef

20.

Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health 2008; 11:44–7PubMedCrossRef

21.

Schwenkglenks M, Lippuner K. Simulation-based cost-utility analysis of population screening-based alendronate use in Switzerland. Osteoporos Int 2007; 18: 1481–91PubMedCrossRef

22.

Lippuner K, Popp A, Szucs TD, et al. Cost-effectiveness of osteoporosis treatment following systematic population screening in Switzerland: impact of the price reduction of the original brand of alendronate [in German]. Pharmacoeconomics — German Research Articles 2008; 6(1): 19–28

23.

Borgstrom F, Carlsson A, Sintonen H, et al. The cost-effectiveness of risedronate in the treatment of osteoporosis: an international perspective. Osteoporos Int 2006; 17: 996–1007PubMedCrossRef

24.

Brecht JG, Kruse HP, Mohrke W, et al. Health-economic comparison of three recommended drugs for the treatment of osteoporosis. Int J Clin Pharmacol Res 2004; 24: 1–10PubMed

25.

Christensen PM, Brixen K, Gyrd-Hansen D, et al. Cost-effectiveness of alendronate in the prevention of osteoporotic fractures in Danish women. Basic Clin Pharmacol Toxicol 2005; 96: 387–96PubMedCrossRef

26.

Hiligsmann M, Ethgen O, Bruyere O, et al. Development and validation of a Markov microsimulation model for the economic evaluation of treatments in osteoporosis. Value Health 2009; 12(5): 687–96PubMedCrossRef

27.

Hiligsmann M, Gathon HJ, Bruyere O, et al. Cost-effectiveness of osteoporosis screening followed by treatment: the impact of medication adherence. Value Health 2010; 13(4): 394–401PubMedCrossRef

28.

Jansen JP, Gaugris S, Bergman G, et al. Cost-effectiveness of a fixed dose combination of alendronate and cholecalciferol in the treatment and prevention of osteoporosis in the United Kingdom and the Netherlands. Curr Med Res Opin 2008; 24: 671–84PubMedCrossRef

29.

Mueller D, Weyler E, Gandjour A. Cost effectiveness of the German screen-and-treat strategy for postmenopausal osteoporosis. Pharmacoeconomics 2008; 26(6): 513–36PubMedCrossRef

30.

Mueller D, Gandjour A. Cost-effectiveness of using clinical risk factors with and without DXA for osteoporosis screening in postmenopausal women. Value Health 2009; 12(8): 1106–17PubMedCrossRef

31.

Strom O, Borgstrom F, Sen SS, et al. Cost-effectiveness of alendronate in the treatment of postmenopausal women in 9 European countries: an economic evaluation based on the fracture intervention trial. Osteoporos Int 2007; 18: 1047–61PubMedCrossRef

32.

van Staa TP, Kanis JA, Geusens P, et al. The cost-effectiveness of bisphosphonates in postmenopausal women based on individual long-term fracture risks. Value Health 2007; 10: 348–57PubMedCrossRef

33.

Arzneimittel-Kompendium der Schweiz® [online]. Available from URL: http://www.kompendium.ch [Accessed 2010 Mar 30]

34.

Kanis JA, Borgstrom F, Johnell O, et al. Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women. Osteoporos Int 2004; 15: 862–71PubMedCrossRef

35.

Siris ES, Selby PL, Saag KG, et al. Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. Am J Med 2009; 122: S3–13PubMedCrossRef

36.

Lippuner K, Johansson H, Kanis JA, et al. Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in Swiss men and women. Osteoporos Int 2009; 20: 1131–40PubMedCrossRef

37.

Finnern HW, Sykes DP. The hospital cost of vertebral fractures in the EU: estimates using national datasets. Osteoporos Int 2003; 14: 429–36PubMedCrossRef

38.

Dansereau RJ, Crail DJ, Perkins AC. In vitro disintegration studies of weekly generic alendronate sodium tablets (70 mg) available in the US. Curr Med Res Opin 2009; 25: 449–52PubMedCrossRef

39.

Halkin H, Dushenat M, Silverman B, et al. Brand versus generic alendronate: gastrointestinal effects measured by resource utilization. Ann Pharmacother 2007; 41: 29–34PubMedCrossRef

40.

Ringe JD, Moller G. Differences in persistence, safety and efficacy of generic and original branded once weekly bisphosphonates in patients with postmenopausal osteoporosis: 1-year results of a retrospective patient chart review analysis. Rheumatol Int 2009; 30: 213–21PubMedCrossRef

41.

Fardellone P, Cortet B, Legrand E, et al. Cost-effectiveness model of using zoledronic acid once a year versus current treatment strategies in postmenopausal osteoporosis. Joint Bone Spine 2010; 77: 53–7PubMedCrossRef

42.

Brankin E, Walker M, Lynch N, et al. The impact of dosing frequency on compliance and persistence with bisphosphonates among postmenopausal women in the UK: evidence from three databases. Curr Med Res Opin 2006; 22: 1249–56PubMedCrossRef

43.

Cramer JA, Lynch NO, Gaudin AF, et al. The effect of dosing frequency on compliance and persistence with bisphosphonate therapy in postmenopausal women: a comparison of studies in the United States, the United Kingdom, and France. Clin Ther 2006; 28: 1686–94PubMedCrossRef

44.

Sambrook P. Quarterly intravenous injection of iban-dronate to treat osteoporosis in postmenopausal women. Clin Interv Aging 2007; 2: 65–72PubMedCrossRef

45.

Cranney A, Wells GA, Yetisir E, et al. Ibandronate for the prevention of nonvertebral fractures: a pooled analysis of individual patient data. Osteoporos Int 2009; 20: 291–7PubMedCrossRef

46.

Demontiero O, Duque G. Once-yearly zoledronic acid in hip fracture prevention. Clin Interv Aging 2009; 4: 153–64PubMed

47.

Frampton JE, Perry CM. Ibandronate: a review of its use in the management of postmenopausal osteoporosis. Drugs 2008; 68(18): 2683–707PubMedCrossRef

48.

Harris ST, Blumentals WA, Miller PD. Ibandronate and the risk of non-vertebral and clinical fractures in women with postmenopausal osteoporosis: results of a meta-analysis of phase III studies. Curr Med Res Opin 2008; 24: 237–45PubMedCrossRef

49.

Brandle M, Goodall G, Erny-Albrecht KM, et al. Cost-effectiveness of pioglitazone in patients with type 2 diabetes and a history of macrovascular disease in a Swiss setting. Swiss Med Wkly 2009; 139: 173–84PubMed

50.

Elbasha EE, Szucs T, Chaudhary MA, et al. Cost-effectiveness of raltegravir in antiretroviral treatment-experienced HIV-1-infected patients in Switzerland. HIV Clin Trials 2009; 10: 233–53PubMedCrossRef

51.

Strom O, Borgstrom F, Kanis JA, et al. Incorporating adherence into health economic modelling of osteoporosis. Osteoporos Int 2009; 20: 23–34PubMedCrossRef

52.

Swiss Health Observatory Inanspruchnahme von Gesundheitsleistungen [online]. Available from URL: http://www.obsan.admin.ch [Accessed 2010 Mar 26]

53.

Cotté FE, Mercier F, De Pouvourville G. Relationship between compliance and persistence with osteoporosis medications and fracture risk in primary health care in France: a retrospective case-control analysis. Clin Ther 2008; 30(12): 2410–22PubMedCrossRef

54.

Höer A, Seidlitz C, Gothe H, et al. Influence on persistence and adherence with oral bisphosphonates on fracture rates in osteoporosis. Patient Prefer Adherence 2009; 3: 25–30PubMed

55.

Penning-van Beest FJ, Erkens JA, Olson M, et al. Loss of treatment benefit due to low compliance with bisphosphonate therapy. Osteoporos Int 2008; 19: 511–7PubMedCrossRef

56.

Sunyecz JA, Mucha L, Baser O, et al. Impact of compliance and persistence with bisphosphonate therapy on health care costs and utilization. Osteoporos Int 2008; 19: 1421–9PubMedCrossRef

57.

Bartl R, Gotte S, Hadji P, et al. Adherence with daily and weekly administration of oral bisphosphonates for osteoporosis treatment. Dtsch Med Wochenschr 2006; 131: 1257–62PubMedCrossRef

58.

Sheehy O, Kindundu CM, Barbeau M, et al. Differences in persistence among different weekly oral bisphosphonate medications. Osteoporos Int 2009; 20: 1369–76PubMedCrossRef

Title: A review of the cost effectiveness of bisphosphonates in the treatment of post-menopausal osteoporosis in Switzerland
Authors: Kurt Lippuner
Richard F. Pollock
Jayne Smith-Palmer
Thomas Meury
Dr William J. Valentine
Publication date: 01-11-2011
Publisher: Springer International Publishing
Published in: Applied Health Economics and Health Policy / Issue 6/2011
Print ISSN: 1175-5652
Electronic ISSN: 1179-1896
DOI: https://doi.org/10.2165/11592210-000000000-00000

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A review of the cost effectiveness of bisphosphonates in the treatment of post-menopausal osteoporosis in Switzerland

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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