地舒单抗治疗绝经后骨质疏松症的成本效果分析。
Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis.
机构信息
Stockholm School of Economics, Box 6501, SE 11383 Stockholm, Sweden.
出版信息
Osteoporos Int. 2011 Mar;22(3):967-82. doi: 10.1007/s00198-010-1424-x. Epub 2010 Oct 9.
UNLABELLED
Denosumab is an injectable drug that reduces the risk of fractures. The objective was to estimate the cost-effectiveness of denosumab in a Swedish setting, also accounting for poor adherence to treatment. Denosumab is cost-effective, particularly for patients at high risk of fracture and low adherence to oral treatments.
INTRODUCTION
Denosumab is a novel biologic agent developed for the treatment of osteoporosis and osteoporotic fractures that has been shown to reduce the risk of fractures in a phase III trial. The objective of this study was to estimate the cost-effectiveness of denosumab from a societal perspective compared with generic alendronate, branded risedronate, strontium ranelate, and no treatment in a Swedish setting.
METHODS
A Markov cohort model was used to estimate the cost-effectiveness of denosumab given for up to 5 years to a typical Swedish patient population (women aged 71 years, T-score ≤ -2.5 SD and a prevalence of morphometric vertebral fractures of 34%). The model included treatment persistence and residual effect after discontinuation assumed to be equal to the time on treatment. Persistence with the comparator treatments and with denosumab was derived from prescription data and a persistence study, respectively.
RESULTS
The base-case incremental cost-effectiveness ratios were estimated at €27,000, €12,000, €5,000, and €14,000, for denosumab compared with generic alendronate, risedronate, strontium ranelate, and no treatment, respectively. Sub-optimal persistence had the greatest impact in the comparison with generic alendronate, where the difference in drug cost was large.
CONCLUSION
Improving persistence with osteoporosis treatment impacts positively on cost-effectiveness with a larger number of fractures avoided in the population targeted for treatment. Denosumab is a cost-effective alternative to oral osteoporosis treatments, particularly for patients at high risk of fracture and low expected adherence to oral treatments.
未标注
地舒单抗是一种注射用药物，可降低骨折风险。本研究旨在评估地舒单抗在瑞典的成本效益，同时考虑治疗依从性差的情况。地舒单抗具有成本效益，尤其是对于骨折风险高且口服治疗依从性低的患者。
引言
地舒单抗是一种新型生物制剂，用于治疗骨质疏松症和骨质疏松性骨折，其在 III 期临床试验中已被证明可降低骨折风险。本研究旨在从社会角度评估地舒单抗与通用阿仑膦酸钠、品牌利塞膦酸钠、雷奈酸锶和不治疗相比在瑞典的成本效益。
方法
使用马尔可夫队列模型来估计地舒单抗的成本效益，该模型在 5 年内用于典型的瑞典患者人群（年龄 71 岁的女性，T 评分≤-2.5 SD 和形态学椎体骨折的患病率为 34%）。该模型包括假设停药后持续治疗和残留效果与治疗时间相等。比较药物的持续时间和地舒单抗的持续时间分别来自处方数据和持续时间研究。
结果
与通用阿仑膦酸钠、利塞膦酸钠、雷奈酸锶和不治疗相比，地舒单抗的增量成本效益比估计值分别为 27000 欧元、12000 欧元、5000 欧元和 14000 欧元。与通用阿仑膦酸钠相比，药物成本差异较大，因此次优的持续治疗对成本效益的影响最大。
结论
改善骨质疏松症治疗的依从性对成本效益产生积极影响，可使目标人群中避免更多的骨折。地舒单抗是口服骨质疏松症治疗的有效替代方案，尤其是对于骨折风险高且口服治疗依从性低的患者。
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