Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
The School of Pharmacy, Fujian Medical University, Fuzhou, China.
Menopause. 2019 Aug;26(8):906-914. doi: 10.1097/GME.0000000000001339.
Osteoporosis has become an important public health problem in China, especially among elderly postmenopausal women. Massive amounts of medical and health resources have been devoted to patients with osteoporosis and osteoporosis-related fractures. This study estimated the cost-effectiveness of alendronate, zoledronate, raloxifene, teriparatide, and calcium/vitamin D as treatments for osteoporosis in elderly postmenopausal women in China from the medical system perspective.
A Markov model was constructed by using TreeAge Pro 2015 software. This model simulated the disease process over 40 years in response to the five investigated therapeutic strategies. Each cycle lasted for 1 year. The model parameters included Chinese epidemiological data, clinical effectiveness, cost, and utility. Total treatment costs and quality-adjusted life-years (QALYs) were estimated, and incremental cost-effectiveness analysis was performed. Univariate and probabilistic sensitivity analyses were conducted to verify the model.
The calcium/vitamin D strategy, zoledronate, alendronate, teriparatide, and raloxifene offered patients 10.24, 10.83, 10.70, 10.88, and 10.54 QALYs at the cost of $3,799.72, $8,425.61, $9,849.89, $34,843.72, and $13,353.33 for over 40 years, respectively. The alendronate and raloxifene strategies were eliminated because they were less effective and more expensive than the other strategies. The base-case analysis revealed that the incremental cost-effectiveness ratios (ICERs) of the zoledronate strategy relative to those of the calcium/vitamin D strategy were $7,864.59/QALY. This result indicated that the zoledronate strategy was more cost-effective than other strategies and was within the willingness-to-pay threshold of China ($28,624/QALY). The ICERs of the teriparatide versus zoledronate strategies were $4,70,797.08/QALY, which exceeded the threshold.
From the perspective of the Chinese medical system, zoledronate is more cost-effective than the calcium/vitamin D strategy, alendronate, raloxifene, and teriparatide for the treatment of osteoporosis in elderly postmenopausal women. Not factoring the parameters of adherence and persistence in, and consequent variability in treatment effectiveness relative risks, seems like a major limitation, but it can be speculated that it would not change the conclusion that zoledronate is the most economical strategy.
骨质疏松症已成为中国一个重要的公共卫生问题，尤其是在老年绝经后妇女中。大量的医疗和卫生资源都用于治疗骨质疏松症患者和骨质疏松性骨折。本研究从医疗系统的角度出发，评估了阿仑膦酸钠、唑来膦酸、雷洛昔芬、特立帕肽和钙/维生素 D 治疗中国老年绝经后妇女骨质疏松症的成本效益。
使用 TreeAge Pro 2015 软件构建了一个 Markov 模型。该模型通过五种治疗策略模拟了 40 年的疾病过程。每个周期持续 1 年。模型参数包括中国的流行病学数据、临床疗效、成本和效用。估计了总治疗成本和质量调整生命年（QALY），并进行了增量成本效益分析。进行了单变量和概率敏感性分析以验证模型。
钙/维生素 D 策略、唑来膦酸、阿仑膦酸钠、特立帕肽和雷洛昔芬的成本分别为 3799.72 美元、8425.61 美元、9849.89 美元、34843.72 美元和 13353.33 美元，为患者提供的 QALY 分别为 10.24、10.83、10.70、10.88 和 10.54。阿仑膦酸钠和雷洛昔芬策略因疗效较低且成本较高而被排除。基于病例分析显示，唑来膦酸策略相对于钙/维生素 D 策略的增量成本效益比（ICER）为 7864.59 美元/QALY。这表明唑来膦酸策略比其他策略更具成本效益，且符合中国（28624 美元/QALY）的支付意愿阈值。特立帕肽与唑来膦酸策略的 ICER 为 4707971.08 美元/QALY，超过了阈值。
从中国医疗体系的角度来看，唑来膦酸治疗老年绝经后妇女骨质疏松症比钙/维生素 D 策略、阿仑膦酸钠、雷洛昔芬和特立帕肽更具成本效益。不考虑依从性和持久性参数以及治疗效果相对风险的变化，似乎是一个主要的局限性，但可以推测，这不会改变唑来膦酸是最经济策略的结论。
