Cost-effectiveness of alendronate in the treatment of postmenopausal women in 9 European countries - an economic evaluation based on the fracture intervention trial

Ström, O.; Borgström, F.; Sen, Shuvayu S.; Boonen, Steven; Haentjens, Patrick; Johnell, Olof; Kanis, John А.

doi:10.1007/s00198-007-0349-5

Cited by 93 publications

(105 citation statements)

References 46 publications

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“…1). The available transitions were similar to those previously published [8][9][10], with the addition of "other fractures", which was a composite health state consisting of pelvis, rib, humerus, tibia, fibula, clavicle, scapula, sternum, and other femoral fractures. The model used a 6-month-cycle length and the cohort was followed from the age of treatment initiation until death, or an age of 100 years.…”

Section: Health Economic Modelsupporting

confidence: 59%

“…Osteoporosis models commonly assume a 5-year treatment duration followed by a period of 5 years (offset time) where the fracture risk linearly returns to the risk of an untreated population [8,9,22]. This offset assumption is reasonable if patients stay on treatment over long periods, as in phase III studies (i.e., 3 years or more), but may not be appropriate in a model that explicitly incorporates discontinuation of treatment.…”

Section: Persistence and Offset Timementioning

confidence: 99%

“…The RR of fracture of patient groups compared to the general population risk was calculated from age, BMD, and the prevalence of vertebral fractures by methods previously described [8,23,24]. The risk contribution from prior vertebral fracture was re-estimated for each cycle to account for age-dependent changes in the prevalence of vertebral fracture in the general population.…”

Section: Assessing Fracture Riskmentioning

confidence: 99%

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Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis

et al. 2010

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Summary-Denosumab is an injectable drug that reduces the risk of fractures. The objective was to estimate the cost-effectiveness of denosumab in a Swedish setting, also accounting for poor adherence to treatment. Denosumab is cost-effective, particularly for patients at high risk of fracture and low adherence to oral treatments.Introduction-Denosumab is a novel biologic agent developed for the treatment of osteoporosis and osteoporotic fractures that has been shown to reduce the risk of fractures in a phase III trial. The objective of this study was to estimate the cost-effectiveness of denosumab from a societal perspective compared with generic alendronate, branded risedronate, strontium ranelate, and no treatment in a Swedish setting.

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Section: Health Economic Modelsupporting

confidence: 59%

Section: Persistence and Offset Timementioning

confidence: 99%

Section: Assessing Fracture Riskmentioning

confidence: 99%

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Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis

et al. 2010

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“…These include new treatment modalities including antibodies to Wnt antagonists e.g., sclerostin [77], cathepsin K inhibitors [78], transdermal PTH peptide formulations [79], and drugs that act on calcium [80]. In addition, there is growing interest in the use of sequential therapy, using antiresorptive drugs to maintain the benefit of anabolic agents, and using mild anti-resorptives after a period of treatment with potent anti-resorptive drugs such as denosumab.…”

Section: Future Developments In the Treatment Of Osteoporosismentioning

confidence: 99%

“…A common assumption [76][77][78][79] is that 30 % of the excess mortality is directly caused by the fracture, which is supported by studies by Parker and Anand [80], Tosteson et al [81] and Kanis et al [82,83]. In this report, it was assumed that 30 % of the excess mortality during the first year was attributable to the fracture itself and that excess mortality related to the fracture was only present during the first year.…”

Section: Page 62 Of 115mentioning

confidence: 99%

Osteoporosis in the European Union: medical management, epidemiology and economic burden

Hernlund¹,

Svedbom²,

Ivergård³

et al. 2013

Arch Osteoporos

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Summary This report describes the epidemiology, burden, and treatment of osteoporosis in the 27 countries of the European Union (EU27). Introduction Osteoporosis is characterized by reduced bone mass and disruption of bone architecture, resulting in increased risk of fragility fractures which represent the main clinical consequence of the disease. Fragility fractures are associated with substantial pain and suffering, disability and even death for affected patients and substantial costs to society. The aim of this report was to characterize the burden of osteoporosis in the EU27 in 2010 and beyond. Methods The literature on fracture incidence and costs of fractures in the EU27 was reviewed and incorporated into a model estimating the clinical and economic burden of osteoporotic fractures in 2010.Results Twenty-two million women and 5.5 million men were estimated to have osteoporosis; and 3.5 million new fragility fractures were sustained, comprising 610,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures and 1,800,000 other fractures (i.e. fractures of the pelvis, rib, humerus, tibia, fibula, clavicle, scapula, sternum and other femoral fractures). The economic burden of incident and prior fragility fractures was estimated at € 37 billion. Incident fractures represented 66 % of this cost, long-term fracture care 29 % and pharmacological prevention 5 %. Previous and incident fractures also accounted for 1,180,000 quality-adjusted life years lost during 2010. The costs are expected to increase by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining.

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Cost-effectiveness of alendronate for the treatment of osteopenic postmenopausal women in Japan

Moriwaki

Komaba

Noto

et al. 2012

Journal of Bone and Mineral Research

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Many postmenopausal women have osteopenia, a condition characterized by loss of bone mineral density (BMD) that is not as severe as in osteoporosis. The objective of this study was to estimate the cost-effectiveness of alendronate to prevent fractures in osteopenic postmenopausal women without a history of fracture in Japan. An individual simulation model was developed to predict lifetime costs and quality-adjusted life years (QALYs) of 5 years of preventive alendronate therapy versus no preventive therapy. The risk of hip and vertebral fracture associated with age and BMD was derived from epidemiologic studies in Japan. We ran the model with different combinations of age (65, 70, and 75 years), BMD (70%, 75%, and 80% of young adult mean [YAM]), and additional clinical risk factors. For 70-year-old women with a BMD of 70% of the YAM having one of the following risk factors: a family history of hip fracture, high alcohol intake, or current smoking, the incremental cost-effectiveness ratio (ICER) of alendronate was $92,937, $126,251, and $129,067 per QALY, respectively. These results were sensitive to age, BMD, and number of clinical risk factors. Probabilistic sensitivity analysis for the base case showed that in the presence of one, two, and three risk factors, alendronate was cost-effective in 0.2% to 2.6%, 13.1% to 56.1%, and 99.1% of the simulations, respectively, if society is willing to pay $50,000 per QALY. Additional analysis indicated that alendronate can be a good value in osteopenic women if the 10-year probability for a osteoporotic hip or vertebral fracture is more than 26.2%. Our results indicate that whether to treat osteopenia with alendronate should be determined on the basis of age, BMD, and number of clinical risk factors in terms of cost-effectiveness. ß

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Cost-effectiveness of alendronate in the treatment of postmenopausal women in 9 European countries - an economic evaluation based on the fracture intervention trial

Cited by 93 publications

References 46 publications

Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis

Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis

Osteoporosis in the European Union: medical management, epidemiology and economic burden

Cost-effectiveness of alendronate for the treatment of osteopenic postmenopausal women in Japan

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