Cost‐effectiveness of bisphosphonates for prevention of fracture related to glucocorticoid‐induced osteoporosis in Malaysia

Abstract

Fracture risk factors of age, previous fracture, rheumatoid arthritis and secondary osteoporosis may modify the cost-effectiveness outcomes of bisphosphonates. Bisphosphonates would be considered cost-effective in patients more than 60 years old as compared to calcium/vitamin D treatments. Further evaluation of the impact of fracture risk factors in larger populations would provide more precise information to better assist rational and economical use of anti-osteoporosis treatment in GIOP patients.

An Updated Systematic Review of Cost-Effectiveness Analyses of Drugs for Osteoporosis

“…Qualityadjusted life-years (QALYs) were used as the outcome in these 23 studies with a model. The remaining four studies used no model [10][11][12]17]. One out of the four conducted a cost-minimization analysis [10], in which costs were compared.…”

“…Another two studies [11,12] used bone mineral density (BMD) as the final outcome and ICER was calculated based on the differences of costs and BMD of different interventions. Furthermore, the number of fracture events was regarded as the outcome in the fourth study [17], ICER was calculated based on the differences of average annual costs divided by the difference of numbers of hip fractures prevented between bisphosphonates and the combination of calcium and vitamin D. Fourteen studies were funded by pharmaceutical companies or national public funds, while 13 studies did not mention the source of funding or had no funding. Table 2 presents characteristics of the studied population, the active intervention and comparator, year of costing valuation, sensitivity analysis, and the main results of the articles.…”

“…Twelve active drugs were assessed in the studies, including various pharmacological treatments such as bisphosphonates (alendronate, etidronate, risedronate, ibandronate, and zoledronic acid), raloxifene, strontium ranelate, denosumab, and teriparatide, and including new agents such as abaloparatide, romosozumab, and gastro-resistant risedronate. Twelve studies included two or more active drugs in their analysis [13,[15][16][17][21][22][23][24][25][26][27][28]. Oral bisphosphonates were included in 11 studies [13-15, 18, 21, 22, 24-26, 29, 30] and compared with other active interventions.…”

“…Oral bisphosphonates were included in 11 studies [13-15, 18, 21, 22, 24-26, 29, 30] and compared with other active interventions. There were three studies [16,20,28] considering sequential therapies as comparators, while six studies [15,17,[30][31][32]36] made the comparison between active osteoporotic drugs and calcium/ vitamin D 3 and ten studies [12, 18, 19, 23-25, 27-29, 33, 34] included no treatment as the comparator. Treatment duration in most studies was similar to randomized controlled trials, indications, or guidelines (e.g., 3 or 5 years for anti-resoptive agents, 12-24 months for anabolic agents).…”