Cost-effectiveness of sequential daily teriparatide/weekly alendronate compared with alendronate monotherapy for older osteoporotic women with prior vertebral fracture in Japan

Abstract

Summary Using a Markov microsimulation model among hypothetical cohorts of community-dwelling older osteoporotic Japanese women with prior vertebral fracture over a lifetime horizon, we found that daily subcutaneous teriparatide for 2 years followed by weekly oral alendronate for 8 years was not cost-effective compared with alendronate monotherapy for 10 years. Purpose Teriparatide has proven efficacy in reducing osteoporotic fractures, but with substantial cost. We examined the cost-effectiveness of sequential teriparatide/alendronate (i.e., daily subcutaneous teriparatide for 2 years followed by weekly oral alendronate for 8 years) compared with alendronate monotherapy for 10 years among community-dwelling older osteoporotic women with prior clinical or morphometric vertebral fracture in Japan. 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 perspective of a single payer responsible for both public healthcare and long-term care. We assumed a lifetime horizon with a willingness-to-pay of ¥5million (or $47,500) per QALY in the base case. We modeled the cost of biosimilar teriparatide, which has been available since November 2019 in Japan, assuming the efficacy was the same as that of the brand version. Results In the base case, sequential teriparatide/alendronate was not cost-effective compared with alendronate monotherapy. In deterministic sensitivity analyses, sequential teriparatide/alendronate would become cost-effective with 85%, 50%, and 15% price discounts to teriparatide at ages 70, 75, and 80, respectively, compared to the current biosimilar cost. Otherwise, results were especially sensitive to changes that affected efficacy of teriparatide or alendronate. In probabilistic sensitivity analyses, the probabilities of sequential teriparatide/alendronate being cost-effective were 0%, 1%, and 37% at ages 70, 75, and 80, respectively. Conclusions Among high-risk osteoporotic women in Japan, sequential teriparatide/alendronate was not cost-effective compared with alendronate monotherapy, even with the availability of biosimilar teriparatide.

Management of patients at very high risk of osteoporotic fractures through sequential treatments

“…Mori et al, studying a Japanese population of older osteoporotic women with prior vertebral fractures compared sequential teriparatide (2 years) followed by alendronate for 8 years, versus alendronate monotherapy. They found, again, that cost-effectiveness was very sensitive to treatment acquisition costs, only becoming cost effective with price discounts to teriparatide of 85%, 50%, and 15% at ages 70, 75, and 80 years, respectively, compared to the current biosimilar cost [ 135 ].…”

Cost-Effectiveness of Sequential Teriparatide/Zoledronic Acid Compared With Zoledronic Acid Monotherapy for Postmenopausal Osteoporotic Women in China

“…Evidence accumulated over the past decade supports that sequential therapy with the initiation of anabolic treatment followed by antiresorptive treatment improves health-related quality-of-life outcomes for individuals with osteoporosis ( 47 ) and our current study reinforces this strategy from the health economic points of view. In the earlier published work, one of the authors of the current study compared sequential daily teriparatide/weekly alendronate with alendronate monotherapy in older osteoporotic women with a prior vertebral fracture in the US ( 18 ) and Japan ( 19 ). Both studies demonstrated that even with the availability of generic teriparatide, sequential teriparatide/alendronate would not be cost-effective unless the cost of generic teriparatide was largely discounted compared with the brand one.…”

“…In real-world practice, persistence and compliance with osteoporosis treatments are reported to be imperfect ( 37 , 38 ). We considered drug persistence and compliance during the therapy based on our published papers in the Japanese or Chinese populations ( 12 , 19 ). Compliance rates with teriparatide and zoledronic acid were higher in clinical than observational studies.…”

Which injected antiosteoporotic medication is worth paying for? A cost-effectiveness analysis of teriparatide, zoledronate, ibandronate, and denosumab for postmenopausal osteoporotic women in China

“…Although in our model the teriparatide strategy had a better therapeutic effect than the no treatment including our assumption that teriparatide reduced the risk of hip fracture, 18,42 the drug cost of teriparatide was estimated to be so expensive even after the adoption of PAP that the ICER of teriparatide compared with no treatment remarkably exceeded the threshold. In this study, we set up two years of the treatment period for teriparatide as there are safety concerns with teriparatide use beyond two years, 21 whereas three years of treatments were provided in the other three injected medications.…”