Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
CNR-NI, Aging Branch-Padua, Padua, Italy.
Osteoporos Int. 2021 Mar;32(3):595-606. doi: 10.1007/s00198-020-05802-5. Epub 2021 Jan 14.
The use of buffered soluble alendronate 70 mg effervescent tablet, a convenient dosing regimen for bisphosphonate therapy, seems a cost-effective strategy compared with relevant alternative treatments for postmenopausal women with osteoporosis aged 60 years and over in Italy.
To assess the cost-effectiveness of buffered soluble alendronate (ALN) 70 mg effervescent tablet compared with relevant alternative treatments for postmenopausal osteoporotic women in Italy.
A previously validated Markov microsimulation model was adjusted to the Italian healthcare setting to estimate the lifetime costs (expressed in €2019) per quality-adjusted life-years (QALY) of buffered soluble ALN compared with generic ALN, denosumab, zoledronic acid and no treatment. Pooled efficacy data derived from the NICE network meta-analysis were used for bisphosphonate treatments. Two treatment duration scenarios were assessed: 1 year using persistence data derived from an Italian prospective observational study including 144 and 216 postmenopausal osteoporotic women on buffered soluble ALN and oral ALN, respectively, and 3 years. Analyses were conducted for women 60-80 years of age with a bone mineral density T-score ≤ - 3.0 or with existing vertebral fractures.
In all simulated populations, buffered soluble ALN was dominant (more QALYs, lower costs) compared to denosumab. The cost per QALY gained of buffered soluble ALN compared to generic ALN and no treatment always falls below €20,000 per QALY gained. In the 1-year treatment scenario, zoledronic acid was associated with more QALY than buffered soluble ALN but the cost per QALY gained of zoledronic acid compared with buffered soluble ALN was always higher than €70,000, while buffered soluble ALN was dominant in the 3-year treatment scenario.
This study suggests that buffered soluble ALN represents a cost-effective strategy compared with relevant alternative treatments for postmenopausal osteoporosis women in Italy aged 60 years and over.
与相关替代治疗相比，使用方便的 70mg 缓冲可溶性阿仑膦酸钠泡腾片（一种双膦酸盐治疗方案）似乎是一种具有成本效益的策略，适用于意大利 60 岁及以上绝经后骨质疏松症女性。
评估与意大利绝经后骨质疏松症女性相关替代治疗相比，缓冲可溶性阿仑膦酸钠（ALN）70mg 泡腾片的成本效益。
调整先前验证的马尔可夫微模拟模型，以评估与意大利卫生保健环境下使用的通用 ALN、地舒单抗、唑来膦酸和不治疗相比，缓冲可溶性 ALN 的终生成本（以 2019 年欧元表示）和每质量调整生命年（QALY）。从 NICE 网络荟萃分析中获取的联合疗效数据用于双膦酸盐治疗。评估了两种治疗持续时间方案：使用从包括 144 名和 216 名分别接受缓冲可溶性 ALN 和口服 ALN 的绝经后骨质疏松症女性的意大利前瞻性观察研究中获得的持久性数据进行 1 年治疗，以及 3 年治疗。分析适用于年龄在 60-80 岁、骨密度 T 评分≤-3.0 或存在椎体骨折的女性。
在所有模拟人群中，与地舒单抗相比，缓冲可溶性 ALN 具有优势（更多 QALYs，更低成本）。与通用 ALN 和不治疗相比，与缓冲可溶性 ALN 相比，成本效益比始终低于每 QALY 20000 欧元。在 1 年治疗方案中，唑来膦酸的 QALY 比缓冲可溶性 ALN 多，但唑来膦酸与缓冲可溶性 ALN 相比的成本效益比始终高于 70000 欧元，而在 3 年治疗方案中，缓冲可溶性 ALN 具有优势。
本研究表明，与意大利 60 岁及以上绝经后骨质疏松症女性的相关替代治疗相比，缓冲可溶性 ALN 是一种具有成本效益的策略。
