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Osteoporosis International

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01-01-2010 | Original Article

Cost-utility of long-term strontium ranelate treatment for postmenopausal osteoporotic women

Authors: M. Hiligsmann, O. Bruyère, J.-Y. Reginster

Published in: Osteoporosis International | Issue 1/2010

Abstract

Summary

The results of this study suggested that long-term treatment with strontium ranelate over 5 years is cost-effective compared to no treatment for postmenopausal osteoporotic women.

Introduction

This study aims to estimate the cost-effectiveness of long-term strontium ranelate treatment for postmenopausal osteoporotic women.

Methods

A validated Markov microsimulation model with a Belgian healthcare cost perspective was used to assess the cost per quality-adjusted life-year (QALY) of strontium ranelate compared to no treatment, on a basis of calcium/vit D supplementation if needed. Analyses were performed for women aged 70, 75, and 80 years either with a bone mineral density T-score ≤ −2.5 SD or with prevalent vertebral fractures. The relative risk of fracture during therapy was derived from the Treatment of Peripheral Osteoporosis Study trial over 5 years of treatment. Parameter uncertainty was evaluated using both univariate and probabilistic sensitivity analyses.

Results

Strontium ranelate was cost-saving at the age of 80 years in both populations. For women with a T-score ≤ −2.5 SD, the costs per QALY gained of strontium ranelate were respectively €15,096 and €6,913 at 70 and 75 years of age while these values were €23,426 and €9,698 for women with prevalent vertebral fractures. Sensitivity analyses showed that the results were robust over a wide range of assumptions.

Conclusion

This study suggested that, compared to no treatment, long-term strontium ranelate treatment is cost-effective for postmenopausal osteoporotic women.

Boonen S, Body JJ, Boutsen Y et al (2005) Evidence-based guidelines for the treatment of postmenopausal osteoporosis: a consensus document of the Belgian Bone Club. Osteoporos Int 16:239–254CrossRefPubMed

Lyles KW, Colon-Emeric CS, Magaziner JS et al (2007) Zoledronic Acid in Reducing Clinical Fracture and Mortality after Hip Fracture. N Engl J Med 357:1799–1809, nihpa40967CrossRefPubMed

Harris ST, Reginster JY, Harley C et al (2009) Risk of fracture in women treated with monthly oral ibandronate or weekly bisphosphonates: The eValuation of IBandronate Efficacy (VIBE) database fracture study. Bone. doi:10.1016/j.bone.2009.01.002

Meunier PJ, Roux C, Seeman E et al (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 350:459–468CrossRefPubMed

Reginster JY, Felsenberg D, Boonen S et al (2008) Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis: results of a five-year, randomized, placebo-controlled trial. Arthritis Rheum 58:1687–1695CrossRefPubMed

Reginster JY, Seeman E, De Vernejoul MC et al (2005) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. J Clin Endocrinol Metab 90:2816–2822CrossRefPubMed

Seeman E, Devogelaer JP, Lorenc R et al (2008) Strontium ranelate reduces the risk of vertebral fractures in patients with osteopenia. J Bone Miner Res 23:433–438CrossRefPubMed

Hoffmann C, Graf von der Schulenburg JM (2000) The influence of economic evaluation studies on decision making. A European survey. The EUROMET group. Health Policy 52:179–192CrossRefPubMed

Drummond M, Dubois D, Garattini L et al (1999) Current trends in the use of pharmacoeconomics and outcomes research in europe. Value Health 2:323–332CrossRefPubMed

10.

Hiligsmann M, Ethgen O, Bruyère O, et al (2009) Development and validation of a Markov microsimulation model for the economic evaluation of treatments in osteoporosis. Value Health. doi:10.1111/j.1524-4733.2008.00497

11.

Cleemput I, Crott R, Vrijens F et al (2008) Recommandations provisoires pour les évaluations pharmacoéconomiques en Belgique. Health Technology Assessment (HTA). Bruxelles: Centre Fédéral d'Expertise des Soins de Santé (KCE). KCE reports vol. 78B (D/2008/10.273/24)

12.

Dere W, Avouac B, Boers M et al (1998) Recommendations for the health economics analysis to be performed with a drug to be registered in prevention or treatment of osteoporosis. Calcif Tissue Int 63:93–97CrossRefPubMed

13.

Reginster JY, Gillet P, Ben Sedrine W et al (1999) Direct costs of hip fractures in patients over 60 years of age in Belgium. Pharmacoeconomics 15:507–514CrossRefPubMed

14.

Autier P, Haentjens P, Bentin J et al (2000) Costs induced by hip fractures: a prospective controlled study in Belgium. Belgian Hip Fracture Study Group. Osteoporos Int 11:373–380CrossRefPubMed

15.

Reginster JY, Gillet P, Gosset C (2001) Secular increase in the incidence of hip fractures in Belgium between 1984 and 1996: need for a concerted public health strategy. Bull World Health Organ 79:942–946PubMed

16.

Gabriel SE, Tosteson AN, Leibson CL et al (2002) Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 13:323–330CrossRefPubMed

17.

Melton LJ 3rd, Gabriel SE, Crowson CS et al (2003) Cost-equivalence of different osteoporotic fractures. Osteoporos Int 14:383–388CrossRefPubMed

18.

Hiligsmann M, Ethgen O, Richy F et al (2008) Utility values associated with osteoporotic fracture: a systematic review of the literature. Calcif Tissue Int 82:288–292CrossRefPubMed

19.

Hiligsmann M, Bruyère O, Ethgen O et al (2008) Lifetime absolute risk of hip and other osteoporotic fracture in Belgian women. Bone 43:991–994CrossRefPubMed

20.

Kanis JA, Johnell O, Oden A et al (2000) Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 27:585–590CrossRefPubMed

21.

Looker AC, Wahner HW, Dunn WL et al (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8:468–489CrossRefPubMed

22.

Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259PubMed

23.

Johnell O, Kanis JA, Oden A et al (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194CrossRefPubMed

24.

Klotzbuecher CM, Ross PD, Landsman PB et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739CrossRefPubMed

25.

Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382CrossRefPubMed

26.

Caulin F, Kanis JA, Johnell O et al (2002) Optimal age for preventing osteoporosis after menopause depends on effects of stopping treatment. Bone 30:754–758CrossRefPubMed

27.

Jonsson B, Kanis J, Dawson A et al (1999) Effect and offset of effect of treatments for hip fracture on health outcomes. Osteoporos Int 10:193–199CrossRefPubMed

28.

Meunier PJ, Roux C, Ortolani S et al (2008) Effects of long-term strontium ranelate treatment on vertebral fracture risk in postmenopausal women with osteoporosis. doi:10.1007/s00198-008-0825-6

29.

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

30.

Borgstrom F, Jonsson B, Strom O et al (2006) An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting: based on the results of the SOTI and TROPOS trials. Osteoporos Int 17:1781–1793CrossRefPubMed

31.

Lekkerkerker F, Kanis JA, Alsayed N et al (2007) Adherence to treatment of osteoporosis: a need for study. Osteoporos Int 18:1311–1317CrossRefPubMed

32.

Rabenda V, Mertens R, Fabri V et al (2008) Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women. Osteoporos Int 19:811–818CrossRefPubMed

33.

Cramer JA, Roy A, Burrell A et al (2008) Medication compliance and persistence: terminology and definitions. Value Health 11:44–47PubMed

34.

Belgian Center for Pharmacotherapeutic Information, 2008, Available from: http://www.cbip.be/GGR/MPG/MPG_NJ.cfm#MP_2583

35.

Kanis J, Burlet N, Cooper C et al (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428CrossRefPubMed

36.

Briggs A, Sculpher M, Claxton K (2006) Modelling methods for health economic evaluation. Oxford University Press, New York

37.

Neuprez A, Hiligsmann M, Scholtissen S et al (2008) Strontium ranelate: the first agent of a new therapeutic class in osteoporosis. Adv Ther 25:1235–1256CrossRefPubMed

38.

Cleemput I, Neyt M, Thiry N et al (2008) Valeurs seuils pour le rapport coût-efficacité en soins de santé. Health Technology Assessment (HTA). Bruxelles: Centre fédéral d'expertise des soins de santé (KCE);2008. KCE Reports 100B (D/2008/10.273/95)

39.

Raftery J (2001) NICE: faster access to moder treatments? Analysis of guidance on health technologies. Br Med J 323:1300–1303CrossRef

40.

Strom O, Borgstrom F, Sen SS et al (2007) 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 18:1047–1061CrossRefPubMed

41.

Borgstrom F, Johnell O, Kanis JA et al (2004) Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden: an economic evaluation based on the MORE study. Pharmacoeconomics 22:1153–1165CrossRefPubMed

42.

Kanis JA, Adams J, Borgstrom F et al (2008) The cost-effectiveness of alendronate in the management of osteoporosis. Bone 42:4–15CrossRefPubMed

43.

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

44.

Borgstrom F, Kanis JA (2008) Health economics of osteoporosis. Best Pract Res Clin Endocrinol Metab 22:885–900CrossRefPubMed

45.

Al MJ, Feenstra T, Brouwer WB (2004) Decision makers' views on health care objectives and budget constraints: results from a pilot study. Health Policy 70:33–48CrossRefPubMed

46.

Mauskopf JA, Sullivan SD, Annemans L et al (2007) Principles of good practice for budget impact analysis: report of the ISPOR Task Force on good research practices—budget impact analysis. Value Health 10:336–347CrossRefPubMed

47.

Bruyere O, Delferriere D, Roux C et al (2008) Effects of strontium ranelate on spinal osteoarthritis progression. Ann Rheum Dis 67:335–339CrossRefPubMed

48.

Marquis P, Roux C, de la Loge C et al (2008) Strontium ranelate prevents quality of life impairment in post-menopausal women with established vertebral osteoporosis. Osteoporos Int 19:503–510CrossRefPubMed

49.

Roux C, Fechtenbaum J, Kolta S et al (2008) Strontium ranelate reduces the risk of vertebral fracture in young postmenopausal women with severe osteoporosis. Ann Rheum Dis 67:335–339PubMed

50.

Drummond M, Barbieri M, Cook J et al (2009) Transferability of economic evaluations across juridictions: ISPOR good research practices task force report. Value Health [Epub Ahead of Print]

Title: Cost-utility of long-term strontium ranelate treatment for postmenopausal osteoporotic women
Authors: M. Hiligsmann
O. Bruyère
J.-Y. Reginster
Publication date: 01-01-2010
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 1/2010
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-009-0924-z

At a glance: The STEP trials

Springer Medicine

Cost-utility of long-term strontium ranelate treatment for postmenopausal osteoporotic women

Abstract

Summary

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

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