Taheri Saeed, Mirzayeh Fashami Fatemeh, Peiravian Farzad, Yousefi Peiravian
Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences.
Iran J Pharm Res. 2019 Spring;18(2):1073-1085. doi: 10.22037/ijpr.2019.1100679.
Teriparatide is a new agent serves as a treatment of choice for severe post-menopausal osteoporotic patients who are at high risk of fracture or have failed or been intolerant of previous osteoporosis therapy. The objective of this study is to estimate the cost-utility of teriparatide compared with no treatment from health system perspective in Iran. A micro-simulation model was developed for a cohort of hypothetical Iranian patient population (women aged 70 years, T-score -2.5 with previous fracture or T-score -3.0 without prior fracture) over a lifetime horizon. The model consisted of the seven health states. During each cycle, patients could have a fracture, remain healthy, remain in a post-fracture state or die. Background fracture risks, mortality rates, persistence rates, utilities, medical and drug costs were derived using published sources. Total accumulated life-time costs and quality-adjusted life years (QALYs) were estimated. Teriparatide was associated with 4.786 QALYs and total direct costs of IRR 143,168,259 over a lifetime horizon. Compared to no treatment, teriparatide provided an additional 0.145 QALY at an incremental cost of IRR 33,511,013. The resulting incremental cost-effectiveness ratio was IRR 230,333,030/QALYs gained. The probabilistic analysis showed that accepting a willingness-to-pay 2 and 3 GDP/capita in Iran, the probability of teriparatide being cost-effective were 51% and 83%, respectively. Compared to no treatment, teriparatide was indicated to be more costly and associated with fewer fractures, more life-years, and more QALYs. The result showed that teriparatide may be considered a cost-effective intervention when targeted to the appropriate patients.
特立帕肽是一种新型药物，是重度绝经后骨质疏松症患者的首选治疗药物，这些患者骨折风险高，或之前的骨质疏松症治疗失败或不耐受。本研究的目的是从伊朗卫生系统的角度评估特立帕肽与不治疗相比的成本效益。针对一组假设的伊朗患者群体（70岁女性，既往有骨折史T值为-2.5或无骨折史T值为-3.0）建立了一个微观模拟模型，评估其终身成本效益。该模型包括七种健康状态。在每个周期中，患者可能发生骨折、保持健康、处于骨折后状态或死亡。背景骨折风险、死亡率、持续率、效用、医疗和药物成本均来自已发表的资料。估计了累积终身总成本和质量调整生命年（QALY）。特立帕肽在终身范围内与4.786个QALY相关，总直接成本为143,168,259伊朗里亚尔。与不治疗相比，特立帕肽以33,511,013伊朗里亚尔的增量成本额外提供了0.145个QALY。由此产生的增量成本效益比为230,333,030伊朗里亚尔/QALY。概率分析表明，在伊朗接受人均2倍和3倍GDP的支付意愿时，特立帕肽具有成本效益的概率分别为51%和83%。与不治疗相比，特立帕肽成本更高，但骨折更少，生命年更多，QALY更多。结果表明，特立帕肽针对合适的患者时可被视为一种具有成本效益的干预措施。
