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Applied Health Economics and Health Policy
Published in: Applied Health Economics and Health Policy 3/2023

10-01-2023 | Bisphosphonate | Original Research Article

Cost Effectiveness of Denosumab for Secondary Prevention of Osteoporotic Fractures Among Postmenopausal Women in China: An Individual-Level Simulation Analysis

Authors: Yawen Jiang, Shan Jiang, Limin Li, Si Shi, Mincai Li, Lei Si

Published in: Applied Health Economics and Health Policy | Issue 3/2023

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Abstract

Objective

This study evaluated the cost effectiveness of denosumab versus alendronate for secondary prevention of osteoporotic fractures among post-menopausal women in China.

Methods

A validated individual-level simulation model of osteoporotic fractures in the Chinese setting was adapted. Allowing both treatment discontinuation and waning effects, the analysis aimed to evaluate the incremental cost-effectiveness ratio of denosumab compared to alendronate by simulating a cohort of previously fractured individuals over the residual lifetime from the healthcare system perspective. Hip, vertebral, and wrist/humeral fractures were tracked along with the associated medical costs and quality-adjusted life-years. Age-related health state utility values, health state utility values of fractures, costs, fracture incidence, and mortality risks for Chinese were used whenever available. Comparative effectiveness data were obtained from a published network meta-analysis. One-way and probabilistic sensitivity analyses were conducted.

Results

In the base case, denosumab was dominated by alendronate with incremental costs of CN¥2743 (US$425) and incremental health outcomes of − 0.20 quality-adjusted life-years at its current price in mainland China. It remained dominated in all one-way sensitivity analysis robustness checks. However, denosumab was cost effective if both drugs did not carry any waning effects. In the probabilistic sensitivity analysis, denosumab remained dominated in all replications.

Conclusions

Denosumab is not cost effective for preventing secondary fractures among overall postmenopausal women in China. It is advisable to identify alternative denosumab regimens for high-risk subgroups among previously fractured postmenopausal women.
Literature
1.
Kanis JA, Black D, Cooper C, et al. A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int. 2002;13(7):527–36.PubMedCrossRef
2.
Bimal G, Sahhar J, Savanur M, et al. Screening rates and prevalence of osteoporosis in a real-world. Austral Syst Scler cohort. 2022;25(2):175–81.
3.
4.
Jiang Y, Ni W. Expected lifetime numbers, risks, and burden of osteoporotic fractures for 50-year old Chinese women: a discrete event simulation incorporating FRAX. J Bone Miner Metab. 2015;18:A643.
5.
Si L, Winzenberg TM, Chen M, et al. Residual lifetime and 10 year absolute risks of osteoporotic fractures in Chinese men and women. Curr Med Res Opin. 2015;31(6):1149–56.PubMedCrossRef
6.
Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359(9321):1929–36.PubMedCrossRef
7.
Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761–7.PubMedCrossRef
8.
Liang H, Zhong W, Ning L. Statistics on the expenses for medical care of osteoporotic fractures in Beijing Jishuitan Hospital (from 2000 to 2006). J Pract Orthopaed. 2009;5:1–25.
9.
Wu J, Qu Y, Wang K, et al. Healthcare resource utilization and direct medical costs for patients with osteoporotic fractures in China. Value Health Reg Issues. 2019;18:106–11.PubMedCrossRef
10.
Kanis JA, Oden A, Johnell O, et al. The components of excess mortality after hip fracture. Bone. 2003;32(5):468–73.PubMedCrossRef
11.
Hasegawa Y, Suzuki S, Wingstrand H. Risk of mortality following hip fracture in Japan. J Orthop Sci. 2007;12(2):113–7.PubMedCrossRef
12.
13.
Appelman-Dijkstra NM, Oei HLDW, Vlug AG, et al. The effect of osteoporosis treatment on bone mass. Best Pract Res Clin Endocrinol Metab. 2022;36(2):101623.PubMedCrossRef
14.
Pedersen AB, Heide-Jørgensen U, Sørensen HT, et al. Comparison of risk of osteoporotic fracture in denosumab vs alendronate treatment within 3 years of initiation. JAMA Netw Open. 2019;2(4):e192416.PubMedPubMedCentralCrossRef
15.
Chandran T, Venkatachalam I. Efficacy and safety of denosumab compared to bisphosphonates in improving bone strength in postmenopausal osteoporosis: a systematic review. Singapore Med J. 2019;60(7):364–78.PubMedPubMedCentralCrossRef
16.
Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis; 2020 update. Endocr Pract. 2020;26:1–46.PubMedCrossRef
17.
Kanis JA, Cooper C, Rizzoli R, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30(1):3–44.PubMedCrossRef
18.
Storm NE, Chang W, Lin TC, et al. A novel case study of the use of real-world evidence to support the registration of an osteoporosis product in China. Ther Innov Regul Sci. 2022;56(1):137–44.PubMedCrossRef
19.
Ni W, Jiang Y. Evaluation on the cost-effective threshold of osteoporosis treatment on elderly women in China using discrete event simulation model. Osteoporos Int. 2017;28(2):529–38.PubMedCrossRef
20.
Caro JJ, Möller J, Karnon J, et al. Discrete event simulation for health technology assessment. New York: CRC Press; 2015.CrossRef
21.
Caro JJ, Möller J. Advantages and disadvantages of discrete-event simulation for health economic analyses. Expert Rev Pharmacoecon Outcomes Res. 2016;16(3):327–9.PubMedCrossRef
22.
Bleibler F, Rapp K, Jaensch A, et al. Expected lifetime numbers and costs of fractures in postmenopausal women with and without osteoporosis in Germany: a discrete event simulation model. BMC Health Serv Res. 2014;14:284.PubMedPubMedCentralCrossRef
23.
Caro JJ. Pharmacoeconomic analyses using discrete event simulation. Pharmacoeconomics. 2005;23(4):323–32.PubMedCrossRef
24.
25.
Hayes KN, Winter EM, Cadarette SM, et al. Duration of bisphosphonate drug holidays in osteoporosis patients: a narrative review of the evidence and considerations for decision-making. J Clin Med. 2021;10(5):1140.PubMedPubMedCentralCrossRef
26.
Husereau D, Drummond M, Augustovski F, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMJ (Clin Res Ed). 2022;376:e067975.
27.
Wang L, Yu W, Yin X, et al. Prevalence of osteoporosis and fracture in China: the China Osteoporosis Prevalence Study. JAMA Netw Open. 2021;4(8):e2121106.PubMedPubMedCentralCrossRef
28.
Si L, Winzenberg TM, Palmer AJ. A systematic review of models used in cost-effectiveness analyses of preventing osteoporotic fractures. Osteoporos Int. 2014;25(1):51–60.PubMedCrossRef
29.
Kung AW, Lee KK, Ho AY, et al. Ten-year risk of osteoporotic fractures in postmenopausal Chinese women according to clinical risk factors and BMD T-scores: a prospective study. J Bone Miner Res. 2007;22(7):1080–7.PubMedCrossRef
30.
Bow CH, Cheung E, Cheung CL, et al. Ethnic difference of clinical vertebral fracture risk. Osteoporos Int. 2012;23(3):879–85.PubMedCrossRef
31.
Gidwani R, Russell LB. Estimating transition probabilities from published evidence: a tutorial for decision modelers. Pharmacoeconomics. 2020;38(11):1153–64.PubMedPubMedCentralCrossRef
32.
Ettinger B, Black D, Dawson-Hughes B, et al. Updated fracture incidence rates for the US version of FRAX®. Osteoporos Int. 2010;21(1):25–33.PubMedCrossRef
33.
Yoshizawa T, Nishino T, Okubo I, et al. Cost-effectiveness analysis of drugs for osteoporosis treatment in elderly Japanese women at high risk of fragility fractures: comparison of denosumab and weekly alendronate. Arch Osteoporos. 2018;13(1):94.PubMedCrossRef
34.
Mori T, Crandall CJ, Fujii T, et al. Cost-effectiveness of zoledronic acid compared with sequential denosumab/alendronate for older osteoporotic women in Japan. Arch Osteoporos. 2021;16(1):113.PubMedPubMedCentralCrossRef
35.
Freemantle N, Cooper C, Diez-Perez A, et al. Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis. Osteoporos Int. 2013;24(1):209–17.PubMedCrossRef
36.
Boschitsch E, Naegele O, Klinger A, et al. Long-term persistence with denosumab: real-world data from the Austrian Osteoporosis Clinic (AOC). A retrospective data analysis Osteoporos Int. 2022;33(1):263–72.PubMed
37.
Lo JC, Pressman AR, Omar MA, et al. Persistence with weekly alendronate therapy among postmenopausal women. Osteoporos Int. 2006;17(6):922–8.PubMedCrossRef
38.
Cummings SR, Ferrari S, Eastell R, et al. Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM trial and its extension. J Bone Miner Res. 2018;33(2):190–8.PubMedCrossRef
39.
Tripto-Shkolnik L, Fund N, Rouach V, et al. Fracture incidence after denosumab discontinuation: real-world data from a large healthcare provider. Bone. 2020;130:115150.PubMedCrossRef
40.
Mori T, Crandall CJ, Ganz DA. Cost-effectiveness of denosumab versus oral alendronate for elderly osteoporotic women in Japan. Osteoporos Int. 2017;28(5):1733–44.PubMedCrossRef
41.
Bliuc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301(5):513–21.PubMedCrossRef
42.
43.
You R, Liu J, Ke L, et al. Cost-effectiveness of sequential denosumab/zoledronic acid compared with zoledronic acid monotherapy for postmenopausal osteoporotic women in China. Front Pharmacol. 2022;13:816248.PubMedPubMedCentralCrossRef
44.
45.
46.
Si L, Winzenberg TM, de Graaff B, et al. A systematic review and meta-analysis of utility-based quality of life for osteoporosis-related conditions. Osteoporos Int. 2014;25(8):1987–97.PubMed
47.
Si L, Shi L, Chen M, et al. Establishing benchmark EQ-5D-3L population health state utilities and identifying their correlates in Gansu Province, China. Qual Life Res. 2017;26(11):3049–58.PubMedCrossRef
48.
Liu G, Wu J, Sun L, et al. China guidelines for pharmacoeconomic evaluations 2019. Beijing: Chinese Pharmaceutical Association; 2019.
49.
Cai D, Shi S, Jiang S, et al. Estimation of the cost-effective threshold of a quality-adjusted life year in China based on the value of statistical life. Eur J Health Econ. 2021;23:607–15.PubMedPubMedCentralCrossRef
50.
51.
Center JR, Bliuc D, Nguyen TV, et al. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA. 2007;297(4):387–94.PubMedCrossRef
52.
You R, Mori T, Ke L, et al. Which injected antiosteoporotic medication is worth paying for? A cost-effectiveness analysis of teriparatide, zoledronate, ibandronate, and denosumab for postmenopausal osteoporotic women in China. Menopause. 2022;29(2):210–8.CrossRef
Metadata
Title
Cost Effectiveness of Denosumab for Secondary Prevention of Osteoporotic Fractures Among Postmenopausal Women in China: An Individual-Level Simulation Analysis
Authors
Yawen Jiang
Shan Jiang
Limin Li
Si Shi
Mincai Li
Lei Si
Publication date
10-01-2023
Publisher
Springer International Publishing
Published in
Applied Health Economics and Health Policy / Issue 3/2023
Print ISSN: 1175-5652
Electronic ISSN: 1179-1896
DOI
https://doi.org/10.1007/s40258-022-00784-3

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