Ebadi Fard Azar Amir Ali, Rezapour Aziz, Alipour Vahid, Sarabi-Asiabar Ali, Gray Serajaddin, Mobinizadeh Mohammadreza, Yousefvand Mani, Arabloo Jalal
Medicine School, Iran University of Medical Sciences, Tehran, Iran.
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2017 Jul 18;31:39. doi: 10.14196/mjiri.31.39. eCollection 2017.
: Hip, vertebral and wrist fractures are the most common consequences of osteoporosis. This study aimed at analyzing the cost-effectiveness of teriparatide (CinnoPar®), compared with alendronate and risedronate, in the treatment of women aged 60 and over with postmenopausal osteoporosis in Iran. : A decision tree model with a 2-year time horizon was used to compare treatment with teriparatide (CinnoPar®) with the following treatment strategies: two years of treatment with alendronate and two years of treatment with risedronate in women aged 60 years and over or those at risk of osteoporosis. Cost per QALY was calculated for 3 treatment strategies from the model. After base case analysis, one-way sensitivity analysis was performed on key parameters of the model to assess their impact on the study results and the cost-effectiveness of different treatment strategies and the model robustness. TreeAge Pro 2006 software was used for modeling and data analysis. : Incremental cost-effectiveness ratio (ICER) of alendronate and teriparatide than risedronate (base treatment) were US$- 2178.03 and US$483,783.67 per QALY, respectively. Therefore, the dominant and cost-effective treatment option was alendronate. In the one-way sensitivity analysis, the impact of annual 25% increase or decrease in the teriparatide cost on its ICER was remarkable. Also, reducing the discount rate from 0.03 to 0.0 had the greatest impact on the ICER of the teriparatide. : The treatment strategy of teriparatide is more expensive than risedronate and alendronate and is associated with very little increase in QALYs. A significant reduction in teriparatide price and a limit in its use only for high-risk women and for acute and short-term treatment courses can contribute to its cost-effectiveness.
髋部、脊椎和腕部骨折是骨质疏松症最常见的后果。本研究旨在分析特立帕肽（欣复泰®）与阿仑膦酸盐和利塞膦酸盐相比，在治疗伊朗60岁及以上绝经后骨质疏松症女性中的成本效益。
使用一个为期2年的决策树模型，将特立帕肽（欣复泰®）治疗与以下治疗策略进行比较：60岁及以上或有骨质疏松症风险的女性接受两年阿仑膦酸盐治疗和两年利塞膦酸盐治疗。从该模型计算出三种治疗策略的每质量调整生命年成本。在进行基本情况分析后，对模型的关键参数进行单向敏感性分析，以评估它们对研究结果、不同治疗策略的成本效益以及模型稳健性的影响。使用TreeAge Pro 2006软件进行建模和数据分析。
阿仑膦酸盐和特立帕肽相对于利塞膦酸盐（基础治疗）的增量成本效益比（ICER）分别为每质量调整生命年-2178.03美元和483783.67美元。因此，占主导地位且具有成本效益的治疗选择是阿仑膦酸盐。在单向敏感性分析中，特立帕肽成本每年增加或减少25%对其ICER的影响显著。此外，将贴现率从0.03降至0对特立帕肽的ICER影响最大。
特立帕肽的治疗策略比利塞膦酸盐和阿仑膦酸盐更昂贵，且质量调整生命年增加很少。大幅降低特立帕肽价格，并将其使用限制在高危女性以及急性和短期治疗疗程中，可能有助于提高其成本效益。
