Mori T, Crandall C J, Ganz D A
Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
Osteoporos Int. 2017 May;28(5):1733-1744. doi: 10.1007/s00198-017-3940-4. Epub 2017 Feb 17.
We constructed a Markov microsimulation model among hypothetical cohorts of community-dwelling elderly osteoporotic Japanese women without prior hip or vertebral fractures over a lifetime horizon. Compared with weekly oral alendronate for 5 years, denosumab every 6 months for 5 years is cost-saving or cost-effective at a conventionally accepted threshold.
The objective of the study was to examine the cost-effectiveness of subcutaneous denosumab every 6 months for 5 years compared with weekly oral alendronate for 5 years in Japan.
We calculated incremental cost-effectiveness ratios [ICERs] (2016 US dollars [$] per quality-adjusted life year [QALY]), using a Markov microsimulation model among hypothetical cohorts of community-dwelling osteoporotic Japanese women without prior hip or vertebral fractures at various ages of therapy initiation (65, 70, 75, and 80 years) over a lifetime horizon from three perspectives: societal, healthcare sector, and government.
Denosumab was cost-saving compared with alendronate at ages 75 and 80 years from any of the three perspectives. The ICERs of denosumab compared with alendronate were $25,700 and $5000 per QALY at ages 65 and 70 years from a societal perspective and did not exceed a willingness-to-pay of $50,000 per QALY from the other two perspectives. In deterministic sensitivity analyses, results were sensitive to changes in the effectiveness of denosumab for reducing hip fracture and clinical vertebral fracture and the rate ratio of non-persistence with denosumab compared to alendronate. In probabilistic sensitivity analyses, the probabilities of denosumab being cost-effective compared with alendronate were 89-100% at a willingness-to-pay of $50,000 per QALY.
Among community-dwelling elderly osteoporotic women in Japan, denosumab every 6 months for 5 years is cost-saving or cost-effective at a conventionally accepted threshold of willingness-to-pay at all ages examined, compared with weekly alendronate for 5 years. This study provides insight to clinicians and policymakers regarding the relative economic value of osteoporosis treatments in elderly women.
我们构建了一个马尔可夫微观模拟模型，用于评估日本社区居住的无髋部或椎体骨折史的老年骨质疏松女性假设队列在其一生中的情况。与每周口服阿仑膦酸钠5年相比，每6个月皮下注射地诺单抗5年在传统认可的阈值下具有成本节约或成本效益。
本研究的目的是在日本比较每6个月皮下注射地诺单抗5年与每周口服阿仑膦酸钠5年的成本效益。
我们使用马尔可夫微观模拟模型，从社会、医疗保健部门和政府三个角度，计算了不同治疗起始年龄（65、70、75和80岁）的日本社区居住的无髋部或椎体骨折史的骨质疏松女性假设队列在其一生中的增量成本效益比[ICERs]（每质量调整生命年[QALY]的2016美元[$]）。
从三个角度中的任何一个来看，在75岁和80岁时，地诺单抗与阿仑膦酸钠相比都具有成本节约。从社会角度来看，65岁和70岁时，地诺单抗与阿仑膦酸钠相比的ICERs分别为每QALY 25,700美元和5000美元，从其他两个角度来看，均未超过每QALY 50,000美元的支付意愿。在确定性敏感性分析中，结果对降低髋部骨折和临床椎体骨折的地诺单抗有效性变化以及地诺单抗与阿仑膦酸钠相比的非持续率比变化敏感。在概率敏感性分析中，每QALY支付意愿为50,000美元时，地诺单抗与阿仑膦酸钠相比具有成本效益的概率为89 - 100%。
在日本社区居住的老年骨质疏松女性中，与每周口服阿仑膦酸钠5年相比，每6个月皮下注射地诺单抗5年在所有研究年龄的传统认可支付意愿阈值下具有成本节约或成本效益。本研究为临床医生和政策制定者提供了有关老年女性骨质疏松治疗相对经济价值的见解。
