Tottori University, Tottori, Japan.
Kobe Gakuin University, Kobe, Japan.
Osteoporos Int. 2021 Oct;32(10):2011-2021. doi: 10.1007/s00198-021-05927-1. Epub 2021 Mar 27.
This study assessed the cost effectiveness of romosozumab versus teriparatide, both sequenced to alendronate, for the treatment of severe postmenopausal osteoporosis in Japan, using bone mineral density (BMD) efficacy data. Results show that romosozumab/alendronate produces greater health benefits at a lower cost than teriparatide/alendronate.
This study aims to assess the cost effectiveness of romosozumab versus teriparatide, both sequenced to alendronate, for the treatment of severe postmenopausal osteoporosis in Japanese women previously treated with bisphosphonates.
A Markov model was used to assess the relative cost effectiveness of 1 year of romosozumab versus 2 years of teriparatide, both sequenced to alendronate for a total treatment duration of 5 years. Outcomes for a cohort of women with a mean age of 78 years, a T-score ≤-2.5 and a previous fragility fracture were simulated over a lifetime horizon. The analysis was conducted from the perspective of the Japanese healthcare system and used a discount rate of 2% per annum. To inform relative fracture incidence, the bone mineral density (BMD) advantage of romosozumab over teriparatide was translated into relative risks of fracture, using relationships provided by a meta-regression of osteoporosis therapy trials. Outcomes were assessed in terms of lifetime costs (2020 US dollars) and quality-adjusted life years (QALYs).
Base case results showed that, compared with teriparatide/alendronate, romosozumab/alendronate reduced costs by $5134 per patient and yielded 0.045 additional QALYs. Scenario analyses and probabilistic sensitivity analysis confirmed that results are robust to uncertainty in model assumptions and inputs.
Results show that romosozumab/alendronate produces greater health benefits at a lower total cost than teriparatide/alendronate.
本研究评估了罗莫佐单抗与特立帕肽序贯阿伦膦酸盐治疗日本绝经后严重骨质疏松症的成本效果，使用骨密度（BMD）疗效数据。结果表明，罗莫佐单抗/阿伦膦酸盐比特立帕肽/阿伦膦酸盐产生更大的健康效益，成本更低。
本研究旨在评估罗莫佐单抗与特立帕肽序贯阿伦膦酸盐治疗日本绝经后骨质疏松症女性的成本效果，这些女性先前曾接受过双膦酸盐治疗。
使用马尔可夫模型评估罗莫佐单抗与特立帕肽序贯阿伦膦酸盐治疗的相对成本效果，每种药物治疗 1 年，总治疗时间为 5 年。模拟了一组平均年龄为 78 岁、T 评分≤-2.5 和先前有脆性骨折的女性患者的终生结局。分析从日本医疗保健系统的角度进行，并使用每年 2%的贴现率。为了了解相对骨折发生率，罗莫佐单抗相对于特立帕肽的 BMD 优势被转化为骨折相对风险，使用骨质疏松症治疗试验的荟萃回归提供的关系。结果以终身成本（2020 年美元）和质量调整生命年（QALYs）表示。
基础案例结果表明，与特立帕肽/阿伦膦酸盐相比，罗莫佐单抗/阿伦膦酸盐使每位患者的成本降低了 5134 美元，并增加了 0.045 个额外的 QALYs。情景分析和概率敏感性分析证实，结果对模型假设和输入的不确定性具有稳健性。
结果表明，与特立帕肽/阿伦膦酸盐相比，罗莫佐单抗/阿伦膦酸盐产生更大的健康效益，总成本更低。
