Cost-effectiveness of teriparatide compared with alendronate and risedronate for the treatment of postmenopausal osteoporosis patients in Iran

Azar, Amir Ali Ebadi Fard; Rezapour, Aziz; Alipour, Vahid; Asiabar, Ali Sarabi; Gray, Serajaddin; Mobinizadeh, Mohammadreza; Yousefvand, Mani; Arabloo, Jalal

doi:10.14196/mjiri.31.39

Cited by 8 publications

(10 citation statements)

References 28 publications

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“…A Markov model was used in 21 studies, consisting of a Markov cohort model ( n = 12) or a Markov microsimulation model ( n = 9). One study applied a discrete-event simulation model [ 16 ], another a decision-tree model [ 13 ]. Quality-adjusted life-years (QALYs) were used as the outcome in these 23 studies with a model.…”

Section: Resultsmentioning

confidence: 99%

“…Given the WTP threshold of US$20,000), raloxifene was not cost effective Karnon et al [ 14 ] Women with a mean age of 72 years (range 60–90 years) with a mean BMD T-score at the femoral neck of − 2.15, and with 24% of women having experienced a previous fracture Patented denosumab vs generic alendronate 2012 Deterministic probabilistic Compared with alendronate, denosumab had an ICER of AUD$246,749 per QALY gained. Given the WTP threshold (AUD$100,000), denosumab is not cost effective Azar et al [ 13 ] Postmenopausal women aged over 60 years with BMD T-score ≤ 2.5 and with at least a previous spine, wrist, or hip fracture caused by osteoporosis Risedronate vs (alendronate and teriparatide) 2014 One-way Compared with risedronate, alendronate and teriparatide had ICERs of US$-2178 and US$483,783 per QALY gained. Given the WTP threshold (US$14,010), alendronate is the dominant and cost-effective treatment option.…”

Section: Resultsmentioning

confidence: 99%

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

Cornelissen

Silverman

et al. 2020

PharmacoEconomics

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Background Considering the heavy economic burden of osteoporotic fractures, the limits of healthcare resources, and the recent availability of new anti-osteoporosis drugs, there is continuing interest in economic evaluation studies of osteoporosis management strategies. Objectives This study aims to (1) systematically review recent economic evaluations of drugs for osteoporosis and (2) to apply an osteoporosis-specific guideline to critically appraise them. Methods A literature search was undertaken using PubMed, EMBASE, National Health Service Economic Evaluation database, and the Cost-Effectiveness Analysis Registry to identify original articles containing economic evaluations of anti-osteoporosis drugs, published between 1 July, 2013 and 31 December, 2019. A recent European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases-International Osteoporosis Foundation (ESCEO-IOF) guideline for the conduct and reporting of economic evaluations in osteoporosis was used to assess the quality of included articles. Results The database search retrieved 3860 records, of which 27 studies fulfilled the inclusion criteria. These studies were conducted in 15 countries; 12 active drugs were assessed, including various traditional pharmacological treatments such as bisphosphonates, raloxifene, strontium ranelate, denosumab, and teriparatide, and new agents such as abaloparatide, romosozumab, and gastro-resistant risedronate. Eight out of 12 studies that compared traditional oral bisphosphonates to other active interventions (denosumab, zoledronic acid, gastro-resistant risedronate, and teriparatide) suggested that the other active agents were generally cost-effective or dominant. Additionally, the cost-effectiveness of sequential therapy has recently been assessed and indications are that it can lead to extra health benefits (larger gains in quality-adjusted life-year). The key drivers of cost effectiveness included baseline fracture risk, drug effect on the risk of fractures, drug cost, and medication adherence/persistence. The current average score for quality assessment was 17 out of 25 (range 2-15); room for improvement was observed for most studies, which could potentially be explained by the fact that most studies were published prior to the osteoporosis-specific guideline. Greater adherence to guideline recommendations was expected for future studies. The quality of reporting was also suboptimal, especially with regard to treatment side effects, treatment effect after discontinuation, and medication adherence. Conclusions This updated review provides an overview of recently published cost-effectiveness analyses. In comparison with a previous review, recent economic evaluations of anti-osteoporosis drugs were conducted in more countries and included more active drugs and sequential therapy as interventions/comparators. The updated economic evidence could help decision makers prioritize health interventions and the unmet/unreported quality issues indicated by the osteoporo...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Cornelissen

Silverman

et al. 2020

PharmacoEconomics

View full text Add to dashboard Cite

show abstract

“…In another study, it is alleged that electroacupuncture is a more cost-effective intervention that NSAIDs in treatment of patients with chronic low back pain from perspective of society [ 33 ]. For osteoporosis, teriparatide is not a cost-effective intervention compared to alendronate and risedronate from health system perspective in the treatment of postmenopausal Iranian women aged 60 years and above [ 34 ]. Rituximab versus disease-modifying anti rheumatoid drugs (DMARDs) is not a cost-effective intervention for the treatment of patients with refractory rheumatoid arthritis from health service perspective [ 35 ].…”

Section: Resultsmentioning

confidence: 99%

QALY league table of Iran: a practical method for better resource allocation

Hashempour

Raei

Lari

et al. 2021

Cost Eff Resour Alloc

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Background The limited health care resources cannot meet all the demands of the society. Thus, decision makers have to choose feasible interventions and reject the others. We aimed to collect and summarize the results of all cost utility analysis studies that were conducted in Iran and develop a Quality Adjusted Life Year (QALY) league table. Methods A systematic mapping review was conducted to identify all cost utility analysis studies done in Iran and then map them in a table. PubMed, Embase, Cochrane library, Web of Science, as well as Iranian databases like Iran Medex, SID, Magiran, and Barakat Knowledge Network System were all searched for articles published from the inception of the databases to January 2020. Additionally, Cost per QALY or Incremental Cost Utility Ratio (ICUR) were collected from all studies. The Joanna Briggs checklist was used to assess quality appraisal. Results In total, 51 cost-utility studies were included in the final analysis, out of which 14 studies were on cancer, six studies on coronary heart diseases. Two studies, each on hemophilia, multiple sclerosis and rheumatoid arthritis. The rest were on various other diseases. Markov model was the commonest one which has been applied to in 45% of the reviewed studies. Discount rates ranged from zero to 7.2%. The cost per QALY ranged from $ 0.144 in radiography costs for patients with some orthopedic problems to $ 4,551,521 for immune tolerance induction (ITI) therapy in hemophilia patients. High heterogeneity was revealed; therefore, it would be biased to rank interventions based on reported cost per QALY or ICUR. Conclusions However, it is instructive and informative to collect all economic evaluation studies and summarize them in a table. The information on the table would in turn be used to redirect resources for efficient allocation. in general, it was revealed that preventive programs are cost effective interventions from different perspectives in Iran.

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“…These patients were provided with additional information to increase their knowledge and possible side effects were addressed and discussed with them either during an additional phone call or during home visit. Previous studies have shown that treatment of osteoporosis with TPTD or other anabolic agents is more expensive than treatment with alendronate or risedronate [26, 27]. To the best of our knowledge, the cost-effectiveness of patient support programs for improving persistence with TPTD has not been published previously.…”

Section: Discussionmentioning

confidence: 99%

Two-year persistence with teriparatide improved significantly after introduction of an educational and motivational support program

et al. 2019

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Summary This study evaluated the 2-year persistence with teriparatide in the Netherlands. Analyses showed that the risk of non-persistence was 28% lower in patients who were followed according to an additional educational and motivational support program. Introduction Until recently, teriparatide (TPTD) was a third-line treatment option for severe osteoporosis in the Netherlands, which could only be prescribed by medical specialists based on a specific medical statement. We aimed to determine whether an educational and motivational support program (EMSP) increased 2-year treatment persistence with TPTD in patients with severe osteoporosis. Methods We evaluated persistence in 1573 Dutch patients treated with TPTD from January 2013 until January 2018. From January 2013 onwards, all patients received a basic support program (BSP) consisting of an educational home visit to initiate TPTD treatment and phone calls (at 1, 2.5 and 8 weeks). Since May 2015, all patients received the EMSP consisting of the BSP extended with evaluation of medication adherence during phone calls, an additional phone call (at 12 months), and motivational letters at 9 and 14 months. Results The EMSP showed a statistically significantly higher 2-year persistence (78%) with TPTD as compared with the BSP (72%). Reasons for treatment discontinuation were comparable between groups, except for the proportion of patients who had stopped TPTD administration due to side effects, which was significantly lower in the EMSP group (8% vs. 15% in BSP, p < 0.001). Overall, the risk of non-persistence was 28% lower in the EMSP compared with the BSP group (HR: 0.72; 95% CI: 0.55–0.93). Conclusion The introduction of the EMSP has demonstrated to improve the persistence with TPTD, resulting in 78% of the patients being persistent with TPTD during the 2-year treatment period. Electronic supplementary material The online version of this article (10.1007/s00198-019-05052-0) contains supplementary material, which is available to authorized users.

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Cost-effectiveness of teriparatide compared with alendronate and risedronate for the treatment of postmenopausal osteoporosis patients in Iran

Cited by 8 publications

References 28 publications

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

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

QALY league table of Iran: a practical method for better resource allocation

Two-year persistence with teriparatide improved significantly after introduction of an educational and motivational support program

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