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Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2021

01-12-2021 | Osteoporosis | Original Article

Cost-effectiveness of zoledronic acid compared with sequential denosumab/alendronate for older osteoporotic women in Japan

Authors: Takahiro Mori, Carolyn J. Crandall, Tomoko Fujii, David A. Ganz

Published in: Archives of Osteoporosis | Issue 1/2021

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Abstract

Summary

Among hypothetical cohorts of older osteoporotic women without prior fragility fracture in Japan, we evaluated the cost-effectiveness of two treatment strategies using a simulation model. Annual intravenous zoledronic acid for 3 years was cost-saving compared with biannual subcutaneous denosumab for 3 years followed by weekly oral alendronate for 3 years.

Purpose

Osteoporosis constitutes a major medical and health economic burden to society worldwide. Injectable treatments for osteoporosis require less frequent administration than oral treatments and therefore have higher persistence and adherence with treatment, which could explain better efficacy for fracture prevention. Although annual intravenous zoledronic acid and biannual subcutaneous denosumab are available, it remains unclear which treatment strategy represents a better value from a health economic perspective. Accordingly, we examined the cost-effectiveness of zoledronic acid for 3 years compared with sequential denosumab/alendronate (i.e., denosumab for 3 years followed by oral weekly alendronate for 3 years, making the total treatment duration 6 years) among hypothetical cohorts of community-dwelling osteoporotic women without prior fragility fracture in Japan at ages 65, 70, 75, or 80 years.

Methods

Using a previously validated and updated Markov microsimulation model, we obtained incremental cost-effectiveness ratios (Japanese yen [¥] (or US dollars [$]) per quality-adjusted life-year [QALY]) from the public healthcare and long-term care payer’s perspective over a lifetime horizon with a willingness-to-pay of ¥5 million (or $47,500) per QALY.

Results

In the base case, zoledronic acid was cost-saving (i.e., more effective and less expensive) compared with sequential denosumab/alendronate. In deterministic sensitivity analyses, results were sensitive to changes in the efficacy of zoledronic acid or the cumulative persistence rate with zoledronic acid or denosumab. In probabilistic sensitivity analyses, the probabilities of zoledronic acid being cost-effective were 98–100%.

Conclusions

Among older osteoporotic women without prior fragility fracture in Japan, zoledronic acid was cost-saving compared with sequential denosumab/alendronate.
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Literature
1.
2.
Mori T, Crandall C, Ganz D (2017) Cost-effectiveness of denosumab versus oral alendronate for elderly osteoporotic women in Japan. Osteoporos Int 28(5):1733–1744CrossRefPubMed
3.
Cummings SR, Ferrari S, Eastell R, Gilchrist N, Jensen JEB, McClung M, Roux C, Törring O, Valter I, Wang AT (2018) Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM trial and its extension. J Bone Miner Res 33(2):190–198CrossRefPubMed
4.
Lyu H, Yoshida K, Zhao SS, Wei J, Zeng C, Tedeschi SK, Leder BZ, Lei G, Tang P, Solomon DH (2020) Delayed denosumab injections and fracture risk among patients with osteoporosis: a population-based cohort study. Ann Intern Med 173 (7):516–526
5.
Tripto-Shkolnik L, Fund N, Rouach V, Chodick G, Shalev V, Goldshtein I (2020) Fracture incidence after denosumab discontinuation: Real-world data from a large healthcare provider. Bone 130:115150
6.
Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D (2019) Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 104(5):1595–1622CrossRefPubMed
7.
Adler RA, El-Hajj Fuleihan G, Bauer DC, Camacho PM, Clarke BL, Clines GA, Compston JE, Drake MT, Edwards BJ, Favus MJ (2016) Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 31(1):16–35CrossRefPubMed
8.
9.
Siu A, Allore H, Brown D, Charles ST, Lohman M (2019) National Institutes of Health Pathways to Prevention Workshop: research gaps for long-term drug therapies for osteoporotic fracture prevention. Ann Intern Med 171(1):51–57CrossRefPubMed
10.
Qaseem A, Forciea MA, McLean RM, Denberg TD (2017) Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians. Ann Intern Med 166(11):818–839CrossRefPubMed
11.
Mori T, Crandall C, Ganz DA (2017) Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA. Osteoporos Int 28(2):585–595CrossRefPubMed
12.
Mori T, Crandall CJ, Ganz DA (2019) Cost-effectiveness of sequential teriparatide/alendronate versus alendronate-alone strategies in high-risk osteoporotic women in the US: analyzing the impact of generic/biosimilar teriparatide. JBMR Plus 3(11):e10233
13.
Mori T, Crandall CJ, Ganz DA (2019) Cost-effectiveness of sequential teriparatide/alendronate versus alendronate-alone strategies in high-risk osteoporotic women in the US: analyzing the impact of generic/biosimilar teriparatide. JBMR plus 3(11):e10233
14.
15.
Mori T, Hamada S, Yoshie S, Jeon B, Jin X, Takahashi H, Iijima K, Ishizaki T, Tamiya N (2019) The associations of multimorbidity with the sum of annual medical and long-term care expenditures in Japan. BMC Geriatr 19(1):69CrossRefPubMedPubMedCentral
16.
Kamae I, Thwaites R, Hamada A, Fernandez JL (2020) Health technology assessment in Japan: a work in progress. J Med Econ 23(4):317–322CrossRefPubMed
17.
Shiroiwa T, Fukuda T, Ikeda S, Takura T, Moriwaki K (2017) Development of an official guideline for the economic evaluation of drugs/medical devices in Japan. Value in Health 20(3):372–378CrossRefPubMed
18.
Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E (2013) Consolidated Health Economic Evaluation Reporting Standards (CHEERS)–explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health 16(2):231–250. https://​doi.​org/​10.​1016/​j.​jval.​2013.​02.​002CrossRefPubMed
19.
Hiligsmann M, Reginster J-Y, Tosteson A, Bukata S, Saag K, Gold D, Halbout P, Jiwa F, Lewiecki EM, Pinto D (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 the US branch of the International Osteoporosis Foundation. Osteoporos Int 30(1):45–57CrossRefPubMed
20.
Orimo H (ed) (2015, Japanese) Japanese guidelines for prevention and treatment of osteoporosis. Life Science, Tokyo
21.
Davis S, Simpson E, Hamilton J, Martyn-St James M, Rawdin A, Wong R, Goka E, Gittoes N, Selby P (2020) Denosumab, raloxifene, romosozumab and teriparatide to prevent osteoporotic fragility fractures: a systematic review and economic evaluation. Health Technol Assess (Winchester, England) 24(29):1CrossRef
22.
23.
Kobayashi K, Ando K, Machino M, Morozumi M, Kanbara S, Ito S, Inoue T, Yamaguchi H, Ishiguro N, Imagama S (2020) Persistence of denosumab terapy among patients with osteoporosis. Asian Spine J 14 (4):453–458
24.
25.
Crandall CJ, Newberry SJ, Diamant A, Lim YW, Gellad WF, Suttorp MJ, Motala A, Ewing B, Roth B, Shanman R, Timmer M, Shekelle PG (2012) Treatment to prevent fractures in men and women with low bone density or osteoporosis: update of a 2007 report: comparative effectiveness review no. 53. Agency for Healthcare Research and Quality; 2012. AHRQ publication 12-EHC023-EF, Rockville, MD
26.
Tamaki J, Fujimori K, Ikehara S, Kamiya K, Nakatoh S, Okimoto N, Ogawa S, Ishii S, Iki M (2019) Estimates of hip fracture incidence in Japan using the National Health Insurance Claim Database in 2012–2015. Osteoporos Int 30(5):975–983CrossRefPubMed
27.
Tsukutani Y, Hagino H, Ito Y, Nagashima H (2015) Epidemiology of fragility fractures in Sakaiminato, Japan: incidence, secular trends, and prognosis. Osteoporos Int 26(9):2249CrossRefPubMed
28.
Black DM, Geiger EJ, Eastell R, Vittinghoff E, Li BH, Ryan DS, Dell RM, Adams AL (2020) Atypical Femur Fracture Risk versus Fragility Fracture Prevention with Bisphosphonates. N Engl J Med 383(8):743–753CrossRefPubMed
29.
30.
31.
You R, Zhang Y, Wu DB-C, Liu J, Qian X, Luo N, Mori T (2020) Cost-Effectiveness of Zoledronic Acid Versus Oral Alendronate for Postmenopausal Osteoporotic Women in China. Front Pharmacol 11:456CrossRefPubMedPubMedCentral
32.
Nawata S, Yamada Y, Ikeda S, Ikegami N (2000) EuroQol study of the elderly general population: relationship with IADL and other attributes. J Health Care and Society 10 (2):75–86, Japanese
33.
34.
35.
Sanders GD, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M, Kuntz KM, Meltzer DO, Owens DK, Prosser LA (2016) Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine. JAMA 316(10):1093–1103CrossRefPubMed
36.
37.
38.
39.
40.
Taguchi Y, Inoue Y, Kido T, Arai N (2018) Treatment costs and cost drivers among osteoporotic fracture patients in Japan: a retrospective database analysis. Arch Osteoporos 13(1):45CrossRefPubMedPubMedCentral
41.
Tamiya N, Noguchi H, Nishi A, Reich M, Ikegami N, Hashimoto H, Shibuya K, Kawachi I, Campbell J (2011) Population ageing and wellbeing: lessons from Japan’s long-term care insurance policy. Lancet (London, England) 378(9797):1183CrossRef
42.
Mori T, Tamiya N, Jin X, Jeon B, Yoshie S, Iijima K, Ishizaki T (2018) Estimated expenditures for hip fractures using merged healthcare insurance data for individuals aged≥ 75 years and long-term care insurance claims data in Japan. Arch Osteoporos 13(1):37CrossRefPubMedPubMedCentral
43.
44.
Freemantle N, Satram-Hoang S, Tang E-T, Kaur P, Macarios D, Siddhanti S, Borenstein J, Kendler D, Investigators D (2012) Final results of the DAPS (Denosumab Adherence Preference Satisfaction) study: a 24-month, randomized, crossover comparison with alendronate in postmenopausal women. Osteoporos Int 23(1):317–326CrossRefPubMed
45.
Anastasilakis AD, Papapoulos SE, Polyzos SA, Appelman-Dijkstra NM, Makras P (2019) Zoledronate for the prevention of bone loss in women discontinuing denosumab treatment. A prospective 2-year clinical trial. J Bone Miner Res 34(12):2220–2228CrossRefPubMed
Metadata
Title
Cost-effectiveness of zoledronic acid compared with sequential denosumab/alendronate for older osteoporotic women in Japan
Authors
Takahiro Mori
Carolyn J. Crandall
Tomoko Fujii
David A. Ganz
Publication date
01-12-2021
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2021
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-021-00956-z

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