Cost-effectiveness of zoledronic acid compared with sequential denosumab/alendronate for older osteoporotic women in Japan

Abstract

Summary Among hypothetical cohorts of older osteoporotic women without prior fragility fracture in Japan, we evaluated the cost-effectiveness of two treatment strategies using a simulation model. Annual intravenous zoledronic acid for 3 years was cost-saving compared with biannual subcutaneous denosumab for 3 years followed by weekly oral alendronate for 3 years. Purpose Osteoporosis constitutes a major medical and health economic burden to society worldwide. Injectable treatments for osteoporosis require less frequent administration than oral treatments and therefore have higher persistence and adherence with treatment, which could explain better efficacy for fracture prevention. Although annual intravenous zoledronic acid and biannual subcutaneous denosumab are available, it remains unclear which treatment strategy represents a better value from a health economic perspective. Accordingly, we examined the cost-effectiveness of zoledronic acid for 3 years compared with sequential denosumab/alendronate (i.e., denosumab for 3 years followed by oral weekly alendronate for 3 years, making the total treatment duration 6 years) among hypothetical cohorts of community-dwelling osteoporotic women without prior fragility fracture in Japan at ages 65, 70, 75, or 80 years. 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 public healthcare and long-term care payer’s perspective over a lifetime horizon with a willingness-to-pay of ¥5 million (or $47,500) per QALY. Results In the base case, zoledronic acid was cost-saving (i.e., more effective and less expensive) compared with sequential denosumab/alendronate. In deterministic sensitivity analyses, results were sensitive to changes in the efficacy of zoledronic acid or the cumulative persistence rate with zoledronic acid or denosumab. In probabilistic sensitivity analyses, the probabilities of zoledronic acid being cost-effective were 98–100%. Conclusions Among older osteoporotic women without prior fragility fracture in Japan, zoledronic acid was cost-saving compared with sequential denosumab/alendronate.

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

“…Since this review including publications up to December 31st 2019, other studies have suggested that sequential treatment may be cost effective [ 133 – 136 ]. Hiligsmann et al limited their population to women with severe osteoporosis in the US (50–80 years with BMD T-score ≤ -3.5 and without a history of prior fracture, or with a T-score of − 2.5 and − 3.5 with a history of ≥ 1 osteoporotic fracture); sequential abaloparatide (18 months) followed by alendronate (5yrs) was compared to generic alendronate monotherapy.…”

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

“…If a participant had a wrist or other bone fracture, corresponding one-time cost and disutility are assigned. Some more pharmacoeconomic evaluations regarding sequential therapy have been reported, which were based on the US or Japanese settings (40,48,49). These two studies in the United States demonstrated that abaloparatide followed by alendronate was dominant compared with sequential teriparatide/alendronate and was cost-effective compared with alendronate monotherapy.…”

Zoledronic acid inhibits osteoclastogenesis and bone resorptive function by suppressing RANKL‑mediated NF‑κB and JNK and their downstream signalling pathways

“…Kondo et al ( 57 ) suggested that sequential therapy using ZOL could suppress decreases in bone mineral density and increase of bone turnover marker if the period of denosumab administration was <3 years. Mori et al ( 58 ) used a simulation model to evaluate the effectiveness and cost of two treatment strategies. It was found that annual i.v.…”