Inserm ERI 12, service de rhumatologie, CHU d'Amiens, 1, place Victor-Pauchet, 80054 Amiens, France.
Joint Bone Spine. 2010 Jan;77(1):53-7. doi: 10.1016/j.jbspin.2009.04.009.
To compare effectiveness, associated cost of outcomes and cost-effectiveness of a single annual infusion of zoledronic acid versus current treatment strategies plans for postmenopausal osteoporosis in France.
Twelve simulation-based models were built to investigate three types of fractures: vertebral (VF), non-vertebral excluding hip (NVF) and hip (HF), comparing two groups: zoledronic acid and current postmenopausal antiosteoporotic treatment strategies. Two effectiveness comparability assumptions have been tested: specific agent efficacy values, and same standard efficacy values for all active agents. Direct medical costs included drug costs, medical visits, monitoring and fracture management. Adherence levels were integrated into the model under the assumption that non-adherent patients had treatment effects similar to the levels of placebo effectiveness.
Using the most conservative assumption (same standard efficacy values for all active agents), zoledronic acid strategy results in less vertebral, non-vertebral and hip fractures than other current antiosteoporotic treatment options over 3 years: 12.04% vs. 14.18%, 10.61% vs. 11.28% and 2.82% vs. 4.64% respectively, (p<0.001). In addition, zoledronic acid is more cost-effective than the current treatment strategies in all types of fractures (p<0.001): 1497 euros vs. 1685 euros per VF avoided, 1337 euros vs. 1404 euros per NVF avoided and 1216 euros vs. 1323 euros per HF avoided.
Zoledronic acid is a cost-effective treatment strategy regardless of fracture type or effectiveness comparability assumptions.
比较唑来膦酸每年一次静脉输注与法国绝经后骨质疏松症现行治疗策略方案在疗效、结局相关成本及成本-效果方面的差异。
建立了 12 个基于模拟的模型，以研究三种类型的骨折：椎体（VF）、非椎体（不包括髋部）（NVF）和髋部（HF），比较两组：唑来膦酸和现行绝经后抗骨质疏松症治疗策略。测试了两种疗效可比性假设：特定药物疗效值和所有活性药物的标准疗效值相同。直接医疗成本包括药物成本、就诊次数、监测和骨折管理。假设不依从的患者的治疗效果与安慰剂的疗效水平相似，将依从水平纳入模型中。
采用最保守的假设（所有活性药物的标准疗效值相同），唑来膦酸策略在 3 年内导致的椎体、非椎体和髋部骨折少于其他现行抗骨质疏松症治疗方案：12.04%比 14.18%、10.61%比 11.28%和 2.82%比 4.64%（p<0.001）。此外，唑来膦酸在所有类型的骨折中都比现行治疗策略更具成本效果（p<0.001）：每避免 1 例 VF 骨折节约 1497 欧元，每避免 1 例 NVF 骨折节约 1337 欧元，每避免 1 例 HF 骨折节约 1216 欧元。
无论骨折类型或疗效可比性假设如何，唑来膦酸都是一种具有成本效果的治疗策略。
