Cost-effectiveness Analysis of Sequential Treatment of Abaloparatide Followed by Alendronate Versus Teriparatide Followed by Alendronate in Postmenopausal Women With Osteoporosis in the United States

Le, Quang A.; Hay, Joel W.; Becker, RV; Wang, Yamei

doi:10.1177/1060028018798034

Cited by 28 publications

(36 citation statements)

References 44 publications

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“…Other than Liu and colleagues' study, there have been three more recent cost‐effectiveness analyses for fracture prevention in the US setting including teriparatide. Unlike our study, however, Hiligsmann and colleagues' and Le and colleagues' studies focused on cost‐effectiveness of sequential treatments of abaloparatide, which was approved in the US in 2017, followed by alendronate, compared with teriparatide followed by alendronate . The Institute for Clinical and Economic Review's study examined the cost‐effectiveness of teriparatide compared with zoledronate or no treatment .…”

Section: Discussionmentioning

confidence: 90%

“…We assumed that alendronate was efficacious at reducing the risk of fractures from the first year through 10th year, and that the risk of fractures after completing the therapy returned to rates in the absence of alendronate over 10 years in a gradual linear fashion (ie, offset effects) . Similarly, we assumed that teriparatide had efficacy from the first year through the second year and the risk for fractures returned to rates in the absence of teriparatide after 3 years, consistent with a recent cost‐effectiveness analysis regarding teriparatide . To keep the model parsimonious, we assumed that each individual obtained benefits of fracture prevention if she persisted in taking the treatment to the end of each cycle (ie, 1 year).…”

Section: Methodsmentioning

confidence: 93%

“…Unlike our study, however, Hiligsmann and colleagues' and Le and colleagues' studies focused on cost-effectiveness of sequential treatments of abaloparatide, which was approved in the US in 2017, followed by alendronate, compared with teriparatide followed by alendronate. (13,14) The Institute for Clinical and Economic Review's study examined the cost-effectiveness of teriparatide compared with zoledronate or no treatment. (12) In this study, the ICER of teriparatide compared with no treatment would be less than $150,000/QALY if the annual cost of teriparatide were $5474 in 2016 dollars, an approximately 77% discount from their cost in base case.…”

Section: Discussionmentioning

confidence: 99%

“…Bisphosphonates are typically prescribed after the completion of teriparatide to prevent bone density decline and loss of fracture efficacy. (1,6,13,14) Although the optimal duration of alendronate has not been determined, those who are at high risk for osteoporotic fractures may benefit from 10 years of therapy. (15)(16)(17) In a sensitivity analysis, we examined the use of teriparatide for 2 years followed by alendronate for 5 years compared with alendronate alone for 5 years.…”

Section: Efficacy Of Treatmentsmentioning

confidence: 99%

“…(10,11) Similarly, we assumed that teriparatide had efficacy from the first year through the second year and the risk for fractures returned to rates in the absence of teriparatide after 3 years, consistent with a recent cost-effectiveness analysis regarding teriparatide. (14) To keep the model parsimonious, we assumed that each individual obtained benefits of fracture prevention if she persisted in taking the treatment to the end of each cycle (ie, 1 year). In addition, for those who discontinued either alendronate or teriparatide before the predetermined period (ie, 2 years for teriparatide, 10 years for alendronate), the offset effects after discontinuation of therapy were assumed to be proportional to the length of the treatment periods.…”

Section: Efficacy Of Treatmentsmentioning

confidence: 99%

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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

2019

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Teriparatide, currently only available in brand form in the United States, is a costly drug approved for the treatment of postmenopausal osteoporotic women who are at high risk of fracture. Because market exclusivity for brand teriparatide expired in August 2019 in the US, we sought to understand the potential health economic impact of the availability of generic or biosimilar (generic/biosimilar) teriparatide. We examined the cost‐effectiveness of daily teriparatide for 2 years followed by weekly alendronate for 10 years (ie, sequential teriparatide/alendronate) compared with alendronate alone for 10 years in community‐dwelling white osteoporotic women with prior vertebral fracture at ages 65, 70, 75, and 80. Using an updated version of previously validated Markov microsimulation models, we obtained incremental cost‐effectiveness ratios (ICERs) (dollars [$] per quality‐adjusted life year [QALY]) with a willingness‐to‐pay (WTP) of $150,000 per QALY from a societal perspective with a lifelong time horizon. In the base case, we estimated the annual cost of teriparatide to be $20,161, based on the assumption of 10% brand usage (at a cost of $27,618) and 90% generic/biosimilar usage (priced 30% lower than brand). The ICERs of sequential teriparatide/alendronate compared with alendronate alone were greater than $280,000 per QALY at all ages examined. In deterministic sensitivity analyses, results were sensitive to teriparatide's cost, with the cost of a generic/biosimilar product needing to be 65% to 85% lower than brand for sequential teriparatide/alendronate to be cost‐effective. In probabilistic sensitivity analyses, under the assumption that the annual cost of teriparatide was $20,161, the probabilities of sequential teriparatide/alendronate being cost‐effective were less than 4% at a WTP of $150,000 per QALY. In conclusion, among community‐dwelling older osteoporotic women with prior vertebral fracture in the US, even with the potential availability of generic/biosimilar teriparatide, sequential teriparatide/alendronate would not be cost‐effective unless the cost of generic/biosimilar teriparatide were heavily discounted with respect to the current brand cost. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 90%

Section: Methodsmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Efficacy Of Treatmentsmentioning

confidence: 99%

Section: Efficacy Of Treatmentsmentioning

confidence: 99%

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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

2019

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A novel economic framework to assess the cost-effectiveness of bone-forming agents in the prevention of fractures in patients with osteoporosis

et al. 2021

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A novel cost-effectiveness model framework was developed to incorporate the elevated fracture risk associated with a recent fracture and to allow sequential osteoporosis therapies to be evaluated. Treating patients with severe osteoporosis after a recent fracture with a bone-forming agent followed by antiresorptive therapy can be cost-effective compared with antiresorptive therapy alone. Incorporating these novel technical attributes in economic evaluations can support appropriate policy and reimbursement decision-making. Purpose To develop a cost-effectiveness model accommodating increased fracture risk after a recent fracture and treatment sequencing. Methods A micro-simulation cost-utility model was developed to accommodate both treatment sequencing and increased risk with recent fracture. The risk of fracture was estimated and simulated using the FRAX® algorithms combined with Swedish registry data on imminent fracture relative risk. In the base-case cost-effectiveness analysis, a sequential treatment starting with a bone-forming agent for 12 months followed by an antiresorptive agent for 48 months initiated immediately after a major osteoporotic fracture (MOF) in a 70-year-old woman with a T-score of 2.5 or less was compared to an antiresorptive treatment alone for 60 months. The model was populated with data relevant for a UK population reflecting a personal social service perspective. Results The cost per additional quality-adjusted life year (QALY) gained in the base-case setting was estimated at £34,584. Sensitivity analyses revealed the sequential treatment to be cost-saving compared with administering a bone-forming treatment alone. Without simulating an elevated fracture risk immediately after a recent fracture, the cost per QALY changed from £34,584 to £62,184. Conclusion Incorporating imminent fracture risk in economic evaluations has a significant impact on the cost-effectiveness when evaluating fracture prevention treatments in patients with osteoporosis who sustained a recent fracture. Bone-forming treatment followed by antiresorptive therapy can be cost-effective compared to antiresorptive therapy alone depending on treatment acquisition costs.

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A systematic review of cost‑effectiveness analyses of sequential treatment for osteoporosis

Tong

Liu

et al. 2022

Osteoporos Int

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Cost-effectiveness Analysis of Sequential Treatment of Abaloparatide Followed by Alendronate Versus Teriparatide Followed by Alendronate in Postmenopausal Women With Osteoporosis in the United States

Cited by 28 publications

References 44 publications

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

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

A novel economic framework to assess the cost-effectiveness of bone-forming agents in the prevention of fractures in patients with osteoporosis

A systematic review of cost‑effectiveness analyses of sequential treatment for osteoporosis

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