Top

Osteoporosis International

Published in:

31-05-2022 | Bisphosphonate | Original Article

Cost-effectiveness of Denosumab for the Treatment of Postmenopausal Osteoporosis in Malaysia

Authors: Y. W. Choo, N. A. Mohd Tahir, M. S. Mohamed Said, S. C. Li, M. Makmor Bakry

Published in: Osteoporosis International | Issue 9/2022

Abstract

Summary

From the perspective of Malaysian health care providers, denosumab was cost-effective in the treatment of postmenopausal osteoporosis, with an optimal outcome starting at age 60 years. Our results provide important insights into the value for money of anti-osteoporotic agents that can serve as a reference for other countries with comparable epidemiological data.

Introduction

The study aimed to compare the cost-effectiveness of denosumab with alendronate and no treatment in the management of postmenopausal osteoporosis among the Malaysian population.

Methods

A well-validated Markov model was used to estimate the cost-effectiveness of denosumab in a hypothetical cohort of postmenopausal osteoporotic women between 50 and 80 years old who had no history of fractures. A 10-year time horizon from the perspective of Malaysian health care providers was used in this analysis. The model parameters, including transition probabilities and costs, were based on Malaysian sources. Treatment efficacy data were obtained from a network meta-analysis. The study outcomes were presented as incremental cost per quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed to ensure the robustness of the results. A cost-effectiveness threshold was set at MYR 21,438 (USD 5175) per QALY.

Results

Denosumab was found to be a cost-effective option for postmenopausal osteoporotic women aged 60 and older. The incremental cost-effectiveness ratios (ICERs) for denosumab versus alendronate ranged from MYR 16,955 (USD 4093) per QALY at age 60 to MYR 4380 (USD 1057) per QALY at age 80. The cost-effectiveness of denosumab improved monotonically with increasing age. Denosumab was 72.8–92.7% likely to be cost-effective at the cost-effectiveness threshold. Sensitivity analyses demonstrated that the results were robust across all parameter variations, with the annual cost of denosumab being the most sensitive.

Conclusions

From the perspective of the Malaysian health care provider, denosumab appears to be a cost-effective treatment choice for postmenopausal osteoporotic women over 60 years of age.

Available only for authorised users

Odén A, McCloskey EV, Kanis JA et al (2015) Burden of high fracture probability worldwide: secular increases 2010–2040. Osteoporos Int 26:2243–2248. https://doi.org/10.1007/s00198-015-3154-6CrossRefPubMed

Department of Statistics Malaysia (2016) Population Projection (Revised), Malaysia, 2010–2040. Malaysia

Cheung C-L, Bin AS, Chadha M et al (2018) An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia 4:16–21. https://doi.org/10.1016/j.afos.2018.03.003CrossRefPubMedPubMedCentral

Pharmaceutical Services Programme (2021) Official Portal of Pharmaceutical Services Programme, Ministry of Health Malaysia. https://www.pharmacy.gov.my/v2/en. Accessed 21 Apr 2021

Fatoye F, Smith P, Gebrye T, Yeowell G (2019) Real-world persistence and adherence with oral bisphosphonates for osteoporosis: a systematic review. BMJ Open 9:e027049. https://doi.org/10.1136/bmjopen-2018-027049CrossRefPubMedPubMedCentral

Cornelissen D, Boonen A, Bours S et al (2020) Understanding patients’ preferences for osteoporosis treatment: the impact of patients’ characteristics on subgroups and latent classes. Osteoporos Int 31:85–96. https://doi.org/10.1007/s00198-019-05154-9CrossRefPubMed

Zhu Y, Huang Z, Wang Y et al (2020) The efficacy and safety of denosumab in postmenopausal women with osteoporosis previously treated with bisphosphonates: a review. J Orthop Transl 22:7–13. https://doi.org/10.1016/j.jot.2019.08.004CrossRef

Chau D, Becker DL, Coombes ME et al (2012) Cost-effectiveness of denosumab in the treatment of postmenopausal osteoporosis in Canada. J Med Econ 15:3–14. https://doi.org/10.3111/13696998.2012.737393CrossRefPubMed

Darbà J, Kaskens L, Vilela FS, Lothgren M (2015) Cost-utility of denosumab for the treatment of postmenopausal osteoporosis in Spain. Clin Outcomes Res 7:105–117. https://doi.org/10.2147/CEOR.S78349CrossRef

10.

Hiligsmann M, Reginster JY (2011) Cost effectiveness of denosumab compared with oral bisphosphonates in the treatment of post-menopausal osteoporotic women in Belgium. Pharmacoeconomics 29:895–911. https://doi.org/10.2165/11539980-000000000-00000CrossRefPubMed

11.

Jönsson B, Ström O, Eisman JA et al (2011) Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis. Osteoporos Int 22:967–982. https://doi.org/10.1007/s00198-010-1424-xCrossRefPubMed

12.

Mori T, Crandall CJ, Ganz DA (2017) Cost-effectiveness of denosumab versus oral alendronate for elderly osteoporotic women in Japan. Osteoporos Int 28:1733–1744. https://doi.org/10.1007/s00198-017-3940-4CrossRefPubMed

13.

Parthan A, Kruse M, Yurgin N et al (2013) Cost effectiveness of denosumab versus oral bisphosphonates for postmenopausal osteoporosis in the US. Appl Health Econ Health Policy 11:485–497. https://doi.org/10.1007/s40258-013-0047-8CrossRefPubMed

14.

Yoshizawa T, Nishino T, Okubo I, Yamazaki M (2018) 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 13:94. https://doi.org/10.1007/s11657-018-0509-6CrossRefPubMed

15.

Karnon J, Shafie AS, Orji N, Usman SK (2016) What are we paying for? A cost-effectiveness analysis of patented denosumab and generic alendronate for postmenopausal osteoporotic women in Australia. Cost Eff Resour Alloc 14:11. https://doi.org/10.1186/s12962-016-0060-5CrossRefPubMedPubMedCentral

16.

Pongchaiyakul C, Nanagara R, Songpatanasilp T, Unnanuntana A (2020) Cost-effectiveness of denosumab for high-risk postmenopausal women with osteoporosis in Thailand. J Med Econ 23:776–785. https://doi.org/10.1080/13696998.2020.1730381CrossRefPubMed

17.

Zethraeus N, Borgström F, Ström O et al (2007) Cost-effectiveness of the treatment and prevention of osteoporosis - a review of the literature and a reference model. Osteoporos Int 18:9–23. https://doi.org/10.1007/s00198-006-0257-0CrossRefPubMed

18.

Ministry of Health Malaysia (2015) Clinical Guidance on Management of Osteoporosis, Second edi. Ministry of Health Malaysia, Malaysia

19.

Ministry of Health Malaysia (2019) Pharmacoeconomic Guidelines for Malaysia, Second edi. Ministry of Health Malaysia, Malaysia

20.

World Health Organization, Baltussen, Rob M. P. M, Adam, Taghreed, Tan-Torres Edejer, Tessa, Hutubessy, Raymond CW et al (‎2003)‎ Making choices in health: WHO guide to cost-effectiveness analysis / edited by T. Tan-Torres Edejer ... [‎et al]‎. Geneva: World Health Organization

21.

Hiligsmann M, Reginster JY, Tosteson ANA et al (2019) Recommendations for the conduct of economic evaluations in osteoporosis: outcomes of an experts’ consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and. Osteoporos Int 30:45–57. https://doi.org/10.1007/s00198-018-4744-xCrossRefPubMed

22.

Husereau D, Drummond M, Augustovski F et al (2022) Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: updated reporting guidance for health economic evaluations. Pharmacoeconomics 2022https://doi.org/10.1007/s40273-021-01112-8

23.

Medical Development Division (2021) Malaysian DRG Executive Information System. In: Minist. Heal. Malaysia. http://casemix-eis.moh.gov.my/. Accessed 1 Feb 2021

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 15:721–739. https://doi.org/10.1359/jbmr.2000.15.4.721CrossRefPubMed

25.

Fleurence RL, Hollenbeak CS (2007) Rates and probabilities in economic modelling: Transformation, translation and appropriate application. Pharmacoeconomics 25:3–6. https://doi.org/10.2165/00019053-200725010-00002CrossRefPubMed

26.

Department of Statistics Malaysia (2020) Vital Statistics, Malaysia, 2020. Malaysia

27.

Chang CY, Tang CH, Chen KC et al (2016) The mortality and direct medical costs of osteoporotic fractures among postmenopausal women in Taiwan. Osteoporos Int 27:665–676. https://doi.org/10.1007/s00198-015-3238-3CrossRefPubMed

28.

Ha YC, Kim TY, Lee A et al (2016) Current trends and future projections of hip fracture in South Korea using nationwide claims data. Osteoporos Int 27:2603–2609. https://doi.org/10.1007/s00198-016-3576-9CrossRefPubMed

29.

Kwon GD, Jang S, Lee A et al (2016) Incidence and mortality after distal radius fractures in adults aged 50 years and older in Korea. J Korean Med Sci 31:630–634. https://doi.org/10.3346/jkms.2016.31.4.630CrossRefPubMedPubMedCentral

30.

Kim TY, Jang S, Park CM et al (2016) Trends of incidence, mortality, and future projection of spinal fractures in Korea using nationwide claims data. J Korean Med Sci 31:801–805. https://doi.org/10.3346/jkms.2016.31.5.801CrossRefPubMedPubMedCentral

31.

Li S, Sun T, Liu Z (2016) Excess mortality of 1 year in elderly hip fracture patients compared with the general population in Beijing, China. Arch Osteoporos 11:35. https://doi.org/10.1007/s11657-016-0289-9CrossRefPubMed

32.

Man LP, Angela Ho AWH, Wong SH (2016) Excess mortality for operated geriatric hip fracture in Hong Kong. Hong Kong Med J 22:6–10. https://doi.org/10.12809/hkmj154568

33.

Kanis JA, Oden A, Johnell O et al (2003) The components of excess mortality after hip fracture. Bone 32:468–473. https://doi.org/10.1016/S8756-3282(03)00061-9CrossRefPubMed

34.

Kanis JA, Oden A, Johnell O et al (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112. https://doi.org/10.1007/s00198-003-1516-yCrossRefPubMed

35.

Barrionuevo P, Kapoor E, Asi N et al (2019) Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: a network meta-analysis. J Clin Endocrinol Metab 104:1623–1630. https://doi.org/10.1210/jc.2019-00192CrossRefPubMed

36.

Ström O, Borgström F, Kanis JA, Jönsson B (2009) Incorporating adherence into health economic modelling of osteoporosis. Osteoporos Int 20:23–34. https://doi.org/10.1007/s00198-008-0644-9CrossRefPubMed

37.

Reyes C, Tebe C, Martinez-Laguna D et al (2017) One and two-year persistence with different anti-osteoporosis medications: a retrospective cohort study. Osteoporos Int 28:2997–3004. https://doi.org/10.1007/s00198-017-4144-7CrossRefPubMed

38.

Hadji P, Kyvernitakis I, Kann PH et al (2016) GRAND-4: the German retrospective analysis of long-term persistence in women with osteoporosis treated with bisphosphonates or denosumab. Osteoporos Int 27:2967–2978. https://doi.org/10.1007/s00198-016-3623-6CrossRefPubMedPubMedCentral

39.

Cheng LI, Durden E, Limone B et al (2015) Persistence and compliance with osteoporosis therapies among women in a commercially insured population in the United States. J Manag Care Pharm 21:824–833. https://doi.org/10.18553/jmcp.2015.21.9.824

40.

Durden E, Pinto L, Lopez-Gonzalez L et al (2017) Two-year persistence and compliance with osteoporosis therapies among postmenopausal women in a commercially insured population in the United States. Arch Osteoporos 12:22. https://doi.org/10.1007/s11657-017-0316-5CrossRefPubMedPubMedCentral

41.

Lakatos P, Takács I, Marton I et al (2016) A retrospective longitudinal database study of persistence and compliance with treatment of osteoporosis in Hungary. Calcif Tissue Int 98:215–225. https://doi.org/10.1007/s00223-015-0082-6CrossRefPubMed

42.

Morley J, Moayyeri A, Ali L et al (2020) Persistence and compliance with osteoporosis therapies among postmenopausal women in the UK Clinical Practice Research Datalink. Osteoporos Int 31:533–545. https://doi.org/10.1007/s00198-019-05228-8CrossRefPubMed

43.

Miyazaki T, Tokimura F, Tanaka S (2014) A review of denosumab for the treatment of osteoporosis. Patient Prefer Adherence 8:463–471. https://doi.org/10.2147/PPA.S46192CrossRefPubMedPubMedCentral

44.

Bone HG, Hosking D, Devogelaer J-P et al (2004) Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 350:1189–1199. https://doi.org/10.1056/nejmoa030897CrossRefPubMed

45.

Black DM, Schwartz AV, Ensrud KE et al (2006) Effects of continuing or stopping alendronate after 5 years of treatment: The Fracture Intervention Trial long-term extension (FLEX): a randomized trial. J Am Med Assoc 296:2927–2938. https://doi.org/10.1001/jama.296.24.2927CrossRef

46.

McClung MR, Wagman RB, Miller PD et al (2017) Observations following discontinuation of long-term denosumab therapy. Osteoporos Int 28:1723–1732. https://doi.org/10.1007/s00198-017-3919-1CrossRefPubMedPubMedCentral

47.

Kendler DL, McClung MR, Freemantle N et al (2011) Adherence, preference, and satisfaction of postmenopausal women taking denosumab or alendronate. Osteoporos Int 22:1725–1735. https://doi.org/10.1007/s00198-010-1378-zCrossRefPubMed

48.

Brown JP, Prince RL, Deal C et al (2009) Comparison of the effect of denosumab and alendronate on BMD and biochemical markers of bone turnover in postmenopausal women with low bone mass: a randomized, blinded, phase 3 trial. J Bone Miner Res 24:153–161. https://doi.org/10.1359/jbmr.0809010CrossRefPubMed

49.

World Bank Group (2021) GDP deflator (base year varies by country) - Malaysia. https://data.worldbank.org/indicator/NY.GDP.DEFL.ZS?end=2019&locations=MY&start=2010. Accessed 15 Feb 2021

50.

Central Bank of Malaysia (2021) Exchange Rates 2019. https://www.bnm.gov.my/exchange-rates. Accessed 1 Mar 2021

51.

Federal Government Gazette (2014) Fees (Medical) (Cost of Services) Order 2014. Attorney General’s Chambers, Malaysia

52.

Ara R, Brazier JE (2011) Using health state utility values from the general population to approximate baselines in decision analytic models when condition-specific data are not available. Value Heal 14:539–545. https://doi.org/10.1016/j.jval.2010.10.029CrossRef

53.

Si L, Winzenberg TM, De Graaff B, Palmer AJ (2014) A systematic review and meta-analysis of utility-based quality of life for osteoporosis-related conditions. Osteoporos Int 25:1987–1997. https://doi.org/10.1007/s00198-014-2636-2CrossRefPubMed

54.

Lim YW, Shafie AA, Chua GN, Ahmad Hassali MA (2017) Determination of cost-effectiveness threshold for health care interventions in Malaysia. Value Heal 20:1131–1138. https://doi.org/10.1016/j.jval.2017.04.002CrossRef

55.

Briggs A, Sculpher M, Claxton K (2006) Decision modelling for health economic evaluation. Oxford University Press

Title: Cost-effectiveness of Denosumab for the Treatment of Postmenopausal Osteoporosis in Malaysia
Authors: Y. W. Choo
N. A. Mohd Tahir
M. S. Mohamed Said
S. C. Li
M. Makmor Bakry
Publication date: 31-05-2022
Publisher: Springer London
Keywords: Bisphosphonate
Osteoporosis
Osteoporosis
Denosumab
Denosumab
Published in: Osteoporosis International / Issue 9/2022
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-022-06444-5

2024 ASCO Annual Meeting

Springer Medicine

Cost-effectiveness of Denosumab for the Treatment of Postmenopausal Osteoporosis in Malaysia

Abstract

Summary

Introduction

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2022

Effects of denosumab treatment on the expression of receptor activator of nuclear kappa-B ligand (RANKL) and TNF-receptor TNFRSF9 after total hip arthroplasty—results from a randomized placebo-controlled clinical trial

Fracture definitions in observational osteoporosis drug effects studies that leverage healthcare administrative (claims) data: a scoping review

Long-term exposure to air pollution increases hip fracture incidence rate and related mortality: analysis of National Hip Fracture Database

Effect of standing frames used in real life on bone remodeling in non-walking children with cerebral palsy

The impact of body mass index on mortality rates of hip fracture patients: a systematic review and meta-analysis

The impact of bone mineral density screening on incident fractures and healthcare resource utilization among postmenopausal breast cancer survivors treated with aromatase inhibitors