You Ruxu, Liu Zijie
Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Pharmacol. 2020 Nov 16;11:575893. doi: 10.3389/fphar.2020.575893. eCollection 2020.
Prevalence of osteoporosis in Chinese postmenopausal women has significantly increased over the past decade and oral bisphosphonates are the most potent antiresorptive drugs. The purpose of the present research was to evaluate the cost-effectiveness of oral alendronate for individuals with osteoporosis. We also assessed the impact of medication compliance and persistence on economic outcomes of alendronate and potential economic evaluations of persistence-enhancing interventions. We constructed an individual-level state-transition model to project health outcomes and costs of oral alendronate for Chinese postmenopausal osteoporotic women. The impact of medication compliance and persistence on economic evaluation was addressed in various scenario analyses. Model inputs were derived from clinical trials and published sources, where available. Deterministic and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties and assumptions on the cost-effectiveness results. Compared with no treatment, alendronate treatment was associated with an additional 0.052 QALYs (quality-adjusted life-years) at an additional cost of USD 738, which yielded an incremental cost-effectiveness ratio (ICER) of USD 14,192.308/QALY. The ICER for the different scenarios (full compliance, full persistence, and both full persistence and full compliance) was USD 4,933.333/QALY, USD 3,006.849/QALY, and USD 2,049.822/QALY, respectively. One-way sensitivity analysis showed the ICER was most sensitive to variations in time horizon and residual effect. Probabilistic sensitivity analysis demonstrated that, at a willingness to pay of USD 29,340/QALY, the probability that oral alendronate therapy will be cost-effective is approximately 80%. The findings support the view that oral alendronate is cost-effective for the treatment of osteoporotic fractures in Chinese postmenopausal women. Medication persistence is found to have a greater impact on cost-effectiveness than compliance and interventions to improve persistence to be an efficient use of resources.
在过去十年中，中国绝经后女性骨质疏松症的患病率显著上升，口服双膦酸盐是最有效的抗吸收药物。本研究的目的是评估口服阿仑膦酸钠对骨质疏松症患者的成本效益。我们还评估了药物依从性和持续性对阿仑膦酸钠经济结果的影响以及增强持续性干预措施的潜在经济评估。我们构建了一个个体水平的状态转换模型，以预测中国绝经后骨质疏松症女性口服阿仑膦酸钠的健康结果和成本。在各种情景分析中探讨了药物依从性和持续性对经济评估的影响。模型输入数据来源于临床试验和已发表的资料（如有）。进行了确定性和概率敏感性分析，以探讨不确定性和假设对成本效益结果的影响。与未治疗相比，阿仑膦酸钠治疗可额外增加0.052个质量调整生命年（QALY），额外成本为738美元，增量成本效益比（ICER）为14,192.308美元/QALY。不同情景（完全依从、完全持续以及完全持续且完全依从）的ICER分别为4,933.333美元/QALY、3,006.849美元/QALY和2,049.822美元/QALY。单向敏感性分析表明，ICER对时间跨度和残留效应的变化最为敏感。概率敏感性分析表明，在支付意愿为29,340美元/QALY时，口服阿仑膦酸钠治疗具有成本效益的概率约为80%。研究结果支持以下观点：口服阿仑膦酸钠治疗中国绝经后女性骨质疏松性骨折具有成本效益。发现药物持续性对成本效益的影响大于依从性，并且改善持续性的干预措施是资源的有效利用。
