Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
Radius Health, Inc., Waltham, MA, United States.
Semin Arthritis Rheum. 2020 Jun;50(3):394-400. doi: 10.1016/j.semarthrit.2020.02.004. Epub 2020 Feb 13.
Emerging evidence supports sequential therapy with anabolic followed by antiresorptive in patients at high-risk of fragility fractures. This study assessed the cost-effectiveness of sequential treatment with abaloparatide (ABL) followed by alendronate (ALN) [(ABL/ALN)] compared to ALN monotherapy and to sequential treatment starting with antiresorptive therapy (ALN/ABL/ALN).
A previously validated Markov microsimulation model was used to estimate the cost-effectiveness of sequential ABL/ALN compared to ALN monotherapy and to sequential ALN/ABL/ALN from a lifetime US payer perspective. In line with practice guidelines, patients were assumed to receive ABL for 18 months followed by 5 years of ALN, or ALN monotherapy for 5 years, or a sequence of ALN for 2 years followed by 18 months of ABL and then by 3 years ALN. Evaluation was conducted for patients aged 50-80 years old with a BMD T-score ≤-3.5 and without a history of prior fracture, or with a T-score between -2.5 and -3.5 and a history of ≥ 1 osteoporotic fracture.
Sequential ABL/ALN was cost-effective (threshold of US$150,000 per QALY) vs generic ALN monotherapy in women ≥60 years with a BMD T-score ≤-3.5 and in women with BMD T-score between -2.5 and -3.5 and history of osteoporotic fracture. In all simulated populations, sequential ABL/ALN therapy was dominant (lower costs, more QALYs) compared with sequential ALN/ABL/ALN, resulting from limited effect of ABL in patients previously treated with an antiresorptive agent.
Sequential ABL/ALN therapy is cost-effective vs ALN monotherapy for US postmenopausal women aged ≥60 years at increased risk of fractures.
越来越多的证据支持在高脆性骨折风险患者中采用先使用合成代谢药物再使用抗吸收药物的序贯治疗。本研究评估了与阿仑膦酸钠（ALN）单药治疗相比，阿巴洛肽（ABL）序贯治疗后再用 ALN（ABL/ALN）与从终生美国支付者角度开始使用抗吸收药物序贯治疗（ALN/ABL/ALN）的成本效益。
使用先前验证的马尔可夫微模拟模型，从终生美国支付者角度估计 ABL/ALN 序贯治疗与 ALN 单药治疗相比的成本效益，以及与 ALN/ABL/ALN 序贯治疗相比的成本效益。根据实践指南，假设患者接受 ABL 治疗 18 个月，然后再接受 5 年 ALN 治疗，或接受 5 年 ALN 单药治疗，或先接受 2 年 ALN 治疗，然后再接受 18 个月 ABL 治疗，再接受 3 年 ALN 治疗。评估年龄在 50-80 岁之间、骨密度 T 评分≤-3.5 且无既往骨折史，或 T 评分在-2.5 至-3.5 之间且有 1 次以上骨质疏松性骨折史的患者。
在骨密度 T 评分≤-3.5 的年龄≥60 岁女性和骨密度 T 评分在-2.5 至-3.5 之间且有骨质疏松性骨折史的女性中，ABL/ALN 序贯治疗比 ALN 单药治疗更具成本效益（每 QALY 低于 150,000 美元）。在所有模拟人群中，与 ALN/ABL/ALN 序贯治疗相比，ABL/ALN 序贯治疗具有成本效益（成本较低，QALYs 较高），这是由于先前使用抗吸收药物的患者中 ABL 的疗效有限。
对于有较高骨折风险的美国绝经后≥60 岁女性，ABL/ALN 序贯治疗比 ALN 单药治疗更具成本效益。
