Liu Hau, Michaud Kaleb, Nayak Smita, Karpf David B, Owens Douglas K, Garber Alan M
Division of Endocrinology and Metabolism, Stanford University, Stanford, Calif, USA.
Arch Intern Med. 2006 Jun 12;166(11):1209-17. doi: 10.1001/archinte.166.11.1209.
Teriparatide is a promising new agent for the treatment of osteoporosis.
The objective of this study was to evaluate the cost-effectiveness of teriparatide-based strategies compared with alendronate sodium for the first-line treatment of high-risk osteoporotic women. We developed a microsimulation with a societal perspective. Key data sources include the Study of Osteoporotic Fractures, the Fracture Intervention Trial, and the Fracture Prevention Trial. We evaluated postmenopausal white women with low bone density and prevalent vertebral fracture. The interventions were usual care (UC) (calcium or vitamin D supplementation) compared with 3 strategies: 5 years of alendronate therapy, 2 years of teriparatide therapy, and 2 years of teriparatide therapy followed by 5 years of alendronate therapy (sequential teriparatide/alendronate). The main outcome measure was cost per quality-adjusted life-year (QALY).
For the base-case analysis, the cost of alendronate treatment was 11,600 dollars per QALY compared with UC. The cost of sequential teriparatide/alendronate therapy was 156,500 dollars per QALY compared with alendronate. Teriparatide treatment alone was more expensive and produced a smaller increase in QALYs than alendronate. For sensitivity analysis, teriparatide alone was less cost-effective than alendronate even if its efficacy lasted 15 years after treatment cessation. Sequential teriparatide/alendronate therapy was less cost-effective than alendronate even if fractures were eliminated during the alendronate phase, although its cost-effectiveness was less than 50,000 dollars per QALY if the price of teriparatide decreased 60%, if used in elderly women with T scores of -4.0 or less, or if 6 months of teriparatide therapy had comparable efficacy to 2 years of treatment.
Alendronate compares favorably to interventions accepted as cost-effective. Therapy with teriparatide alone is more expensive and produces a smaller increase in QALYs than therapy with alendronate. Sequential teriparatide/alendronate therapy appear expensive but could become more cost-effective with reductions in teriparatide price, with restriction to use in exceptionally high-risk women, or if short courses of treatment have comparable efficacy to that observed in clinical trials.
特立帕肽是一种用于治疗骨质疏松症的有前景的新型药物。
本研究的目的是评估与阿仑膦酸钠相比，以特立帕肽为基础的策略用于一线治疗高危骨质疏松症女性的成本效益。我们从社会角度开展了微观模拟。主要数据来源包括骨质疏松性骨折研究、骨折干预试验和骨折预防试验。我们评估了绝经后骨密度低且有椎体骨折史的白人女性。干预措施包括常规护理（UC）（补充钙或维生素D），并与3种策略进行比较：5年阿仑膦酸钠治疗、2年特立帕肽治疗，以及2年特立帕肽治疗后再进行5年阿仑膦酸钠治疗（序贯特立帕肽/阿仑膦酸钠）。主要结局指标是每质量调整生命年（QALY）的成本。
对于基础病例分析，与常规护理相比，阿仑膦酸钠治疗的成本为每QALY 11,600美元。与阿仑膦酸钠相比，序贯特立帕肽/阿仑膦酸钠治疗的成本为每QALY 156,500美元。单独使用特立帕肽治疗比阿仑膦酸钠更昂贵，且QALY的增加幅度更小。对于敏感性分析，即使特立帕肽在停药后疗效持续15年，单独使用特立帕肽的成本效益仍低于阿仑膦酸钠。序贯特立帕肽/阿仑膦酸钠治疗的成本效益也低于阿仑膦酸钠，即使在阿仑膦酸钠治疗阶段消除了骨折，不过，如果特立帕肽价格降低60%、用于T值为-4.0或更低的老年女性，或者6个月特立帕肽治疗的疗效与2年治疗相当，其成本效益低于每QALY 50,000美元。
与被认为具有成本效益的干预措施相比，阿仑膦酸钠具有优势。单独使用特立帕肽治疗比阿仑膦酸钠治疗更昂贵，且QALY的增加幅度更小。序贯特立帕肽/阿仑膦酸钠治疗似乎昂贵，但随着特立帕肽价格降低、限制用于极高风险女性，或者如果短疗程治疗的疗效与临床试验中观察到的相当，其成本效益可能会提高。
