Marques Andréa, Lourenço Óscar, Ortsäter Gustaf, Borgström Fredrik, Kanis John A, da Silva José António P
Rheumatology Department, Centro Hospitalar Universitário de Coimbra, 3000-075, Coimbra, Portugal.
Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal.
Calcif Tissue Int. 2016 Aug;99(2):131-41. doi: 10.1007/s00223-016-0132-8. Epub 2016 Mar 25.
Cost-effective intervention thresholds (ITs) based on FRAX(®) were determined for Portugal. Assuming a willingness to pay (WTP) of €32,000 per quality-adjusted life years (QALYs), treatment with generic alendronate is cost effective for men and women aged 50 years or more, with 10-year probabilities for major osteoporotic fractures and hip above 8.8 and 2.5 %, respectively. The aim of the present study was to identify the 10-year probabilities of a major and hip osteoporotic fracture using FRAX(®) validated for Portugal, above which pharmacologic interventions become cost effective in the Portuguese context. A previously developed and validated state transition Markov cohort model was populated with epidemiologic, economic and quality-of-life fracture data from Portugal. Cost-effectiveness of FRAX(®)-based ITs was calculated for generic alendronate and proprietary zoledronic acid, denosumab and teriparatide were compared to "no intervention", assuming a WTP of €32,000 (two times national Gross Domestic Product per capita) per QALYs. In the Portuguese epidemiological and economic context, treatment with generic alendronate was cost effective for men and women aged 50 years or more, with 10-year probabilities at or above 8.8 % for major osteoporotic fractures and 2.5 % for hip fractures. Cost-effective threshold 10-year probabilities for major osteoporotic and hip fractures were higher for zoledronic acid (20.4 and 10.1 %), denosumab (34.9 and 10.1 %) and teriparatide (77.8 and 62.6 %), respectively. A tool is provided to perform the calculation of cost-effective ITs for different medications, according to age group and diverse levels of WTP. Cost-effective ITs, for different medications, age groups and WTP, based on 10-year probabilities of major and hip fracture probabilities calculated with FRAX are provided.
已确定葡萄牙基于FRAX（®）的性价比高的干预阈值（ITs）。假设每质量调整生命年（QALYs）的支付意愿（WTP）为32,000欧元，对于50岁及以上的男性和女性，使用阿仑膦酸钠仿制药进行治疗具有成本效益，其10年发生主要骨质疏松性骨折和髋部骨折的概率分别高于8.8%和2.5%。本研究的目的是使用经葡萄牙验证的FRAX（®）确定10年主要骨质疏松性骨折和髋部骨折的概率，超过该概率，药物干预在葡萄牙背景下将具有成本效益。一个先前开发并验证的状态转换马尔可夫队列模型填充了来自葡萄牙的流行病学、经济和生活质量骨折数据。假设每QALYs的WTP为32,000欧元（人均国内生产总值的两倍），计算了基于FRAX（®）的ITs对于阿仑膦酸钠仿制药的成本效益，并将唑来膦酸原研药、地诺单抗和特立帕肽与“不干预”进行了比较。在葡萄牙的流行病学和经济背景下，对于50岁及以上的男性和女性，使用阿仑膦酸钠仿制药进行治疗具有成本效益，其10年发生主要骨质疏松性骨折的概率等于或高于8.8%，髋部骨折概率为2.5%。唑来膦酸（20.4%和10.1%）、地诺单抗（34.9%和10.1%）和特立帕肽（77.8%和62.6%）的主要骨质疏松性骨折和髋部骨折的成本效益阈值10年概率分别更高。提供了一种工具，可根据年龄组和不同的WTP水平计算不同药物的成本效益ITs。提供了基于用FRAX计算的10年主要骨折和髋部骨折概率的不同药物、年龄组和WTP的成本效益ITs。
