Cost Effectiveness of Denosumab Compared with Oral Bisphosphonates in the Treatment of Post-Menopausal Osteoporotic Women in Belgium

Abstract

Background: Denosumab has recently been shown to be well tolerated, to increase bone mineral density (BMD) and to significantly reduce the risk of hip, vertebral and non-vertebral fractures in the FREEDOM (Fracture REduction Evaluation of Denosumab in Osteoporosis every 6 Months) trial. It is becoming increasingly important to evaluate not only the therapeutic value of a new drug but also the cost effectiveness compared with the most relevant treatment alternatives. Objective: The objective of this study was to estimate the cost effectiveness of denosumab compared with oral bisphosphonates (branded and generic drugs) in the treatment of post-menopausal osteoporotic women in Belgium. Methods: Cost effectiveness of 3 years of treatment with denosumab was compared with branded risedronate and branded and generic alendronate using an updated version of a previously validated Markov microsimulation model. The model was populated with relevant cost, adherence and epidemiological data for Belgium from a payer perspective and the results were presented as costs per QALY gained (h, year 2009 values). Analyses were performed in populations (aged ‡60 years) in which osteoporosis medications are currently reimbursed in many European countries, i.e. those with BMD T-score of -2.5 or less or prevalent vertebral fracture. Patients receiving denosumab were assumed to have a 46% lower risk of discontinuation than those receiving oral bisphosphonates, and the effect of denosumab after treatment cessation was assumed to decline linearly to zero over a maximum of 1 year. Results: Denosumab was cost effective compared with all other therapies, assuming a willingness to pay of h40 000 per QALY gained. In particular, denosumab was found to be cost effective compared with branded alendronate and risedronate at a threshold value of h30 000 per QALY and denosumab was dominant (i.e. lower cost and greater effectiveness) compared with risedronate from the age of 70 years in women with a T-score of -2.5 or less and no prior fractures. The cost effectiveness of denosumab compared

Systematic review of the use of bone turnover markers for monitoring the response to osteoporosis treatment: the secondary prevention of fractures, and primary prevention of fractures in high-risk groups

“…184 The remaining eight papers were conducted for western European countries. [185][186][187][188][189][190][191][192] Five studies were conducted by the same authors in Belgium, [188][189][190][191][192] (these are included separately because there were slight variations in the methods used), one was undertaken in the UK, 187 one in Sweden, 185 and one in the Netherlands and the UK. 186 …”

“…The objectives of the studies were to estimate the cost-effectiveness of different treatments for osteoporosis; [186][187][188]190 to model adherence or persistence to treatments of osteoporosis; 182,183,185,189,191,192 to model the cost-effectiveness of a multifaceted intervention to improve osteoporotic care by encouraging patients to come forward and receive treatment after fracture of the wrist; 184 and to evaluate different follow-up regimes for antiresorptive treatments for post-menopausal women with osteoporosis.…”

“…167, 182,[185][186][187][188][189][190][191][192] Nine studies used the term 'persistence'. [183][184][185][187][188][189][190][191][192] In Chapter 3 (see Assessment of clinical effectiveness) we adopted standard definitions for adherence, compliance and persistence owing to variation in their use.…”

“…[183][184][185][187][188][189][190][191][192] In Chapter 3 (see Assessment of clinical effectiveness) we adopted standard definitions for adherence, compliance and persistence owing to variation in their use. Persistence is the time until discontinuation of medication, compliance is the proportion of medication taken, and adherence is a combination of persistence and compliance.…”

Pharmacological Treatment of Osteoporosis

“…In particular, denosumab was found to be cost effective compared with branded alendronate and risedronate at a threshold value of €30,000 per QALY and denosumab was dominant (lower cost and greater effectiveness) compared with risedronate from the age of 70 years in women with a T-score of -2.5 or less and no prior fractures. (Hiligsmann & Reginster, 2011) 3. Anabolic agents…”