Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
Ministry of Health, Singapore, Singapore.
Osteoporos Int. 2021 Jan;32(1):133-144. doi: 10.1007/s00198-020-05536-4. Epub 2020 Aug 14.
Cost-effectiveness analysis of FRAX® intervention thresholds (ITs) in Singaporean women > 50 years of age showed that generic alendronate was cost-effective at age-dependent major osteoporotic fracture (MOF) IT from the ages of 65 years for both full and real-world adherence whilst hip fracture (HF) ITs were cost-effective from the ages of 60 and 65 years. Alendronate was cost-effective irrespective of age only at fixed MOF IT of 14% and HF IT of 3.5%.
FRAX®-based intervention thresholds (ITs) were recently identified for osteoporosis management in Singapore. This study aimed to assess the cost-effectiveness of ITs in Singaporean women over the age of 50 years.
A validated Markov microsimulation model was used to estimate the lifetime healthcare costs (SGD2019) per quality-adjusted life-years (QALY) of generic alendronate compared with no treatment. Cost-effectiveness of age-dependent FRAX® major osteoporotic fracture (MOF) and hip fracture (HF) ITs was explored. In addition, ITs that would lead to cost-effectiveness were computed. Fracture incidence and cost data were obtained from the Ministry of Health and a previously published Singaporean study. A cost-effectiveness threshold of SGD 62,500/QALY gained was used, based conservatively on 0.7 times the Singapore GDP per capita.
Generic alendronate was shown to be cost-effective at MOF ITs from the ages of 65 years, while HF ITs were cost-effective from the ages of 60 and 65 years, assuming full and real-world adherence, respectively. A 14% MOF and a 3.5% HF ITs were required for alendronate to be cost-effective above 50 years.
This study suggests that the treatment of Singaporean women with alendronate is cost-effective at age-dependant FRAX® intervention thresholds at 65 years and older. Furthermore, identifying women at any age above 50 years with a 10-year risk of MOF or HF of 14% or 3.5% would lead to efficient use of resources. Cost-effective access to therapy for patients at high fracture probability based on FRAX® could contribute to reduce the growing burden of osteoporotic fractures in Singapore.
最近确定了基于 FRAX®的干预阈值 (IT) 用于新加坡骨质疏松症的管理。本研究旨在评估这些 IT 在 50 岁以上新加坡女性中的成本效益。
使用经过验证的马尔可夫微模拟模型来估算与不治疗相比，普通阿仑膦酸钠的终生医疗保健成本 (SGD2019) 每质量调整生命年 (QALY)。探讨了年龄依赖性 FRAX®主要骨质疏松性骨折 (MOF) 和髋部骨折 (HF) IT 的成本效益。此外，还计算了会导致成本效益的 IT。骨折发生率和成本数据来自卫生部和之前发表的新加坡研究。使用基于保守的新加坡人均国内生产总值的 0.7 倍，设定了 62,500 新元/QALY 的成本效益阈值。
假设完全和真实世界的依从性，普通阿仑膦酸钠在 MOF IT 年龄 65 岁及以上，HF IT 年龄 60 岁及以上时具有成本效益。需要 14%的 MOF 和 3.5%的 HF IT，以使阿仑膦酸钠在 50 岁以上时具有成本效益。
本研究表明，在年龄依赖性 FRAX®干预阈值为 65 岁及以上时，用阿仑膦酸钠治疗新加坡女性是具有成本效益的。此外，确定任何年龄在 50 岁以上且 10 年 MOF 或 HF 风险为 14%或 3.5%的女性将有助于有效地利用资源。根据 FRAX®为高骨折概率患者提供具有成本效益的治疗方法可能有助于减轻新加坡不断增加的骨质疏松性骨折负担。
