台湾地区绝经后骨质疏松症应用地舒单抗治疗的真实世界成本效果分析。
Real-world cost-effectiveness of denosumab for the treatment of postmenopausal osteoporosis in Taiwan.
机构信息
Amgen Ltd, Uxbridge, UK.
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
出版信息
Arch Osteoporos. 2021 Oct 12;16(1):155. doi: 10.1007/s11657-021-01020-6.
UNLABELLED
This study assessed the cost-effectiveness of continued denosumab treatment, compared with discontinuation of denosumab after one dose, for the treatment of postmenopausal osteoporosis in Taiwan, using real-world fracture reduction effectiveness and cost data. Outcomes indicate that continued denosumab treatment produces an incremental cost-effectiveness ratio of USD $16,743 per QALY.
PURPOSE
To evaluate the cost-effectiveness of continued denosumab use versus discontinuation after one dose, for the treatment of postmenopausal osteoporosis in Taiwan, using real-world fracture reduction effectiveness and cost data.
METHODS
A Markov cohort model was used to evaluate the lifetime costs and QALYs associated with continued denosumab treatment versus discontinuation of treatment after one dose. The evaluation was conducted from the perspective of Taiwan's healthcare system and used a discount rate of 3% per annum. The patient population consisted of postmenopausal women with osteoporosis with a mean age of 77 years who initiated denosumab treatment. Fracture reduction effectiveness data, baseline fracture rates, mortality data, and costs of fracture were informed by Taiwan's National Health Insurance Research Database.
RESULTS
Model outcomes showed that continued treatment with denosumab produced an expected gain of 0.042 QALYs and an incremental cost of USD $704, compared with discontinuation of denosumab after one dose. This corresponds to an incremental cost-effectiveness ratio of USD $16,743 per QALY gained. Probabilistic and scenario analysis showed that results are stable to variations in model assumptions and parameters.
CONCLUSION
In a real-world setting, at a cost per QALY threshold equivalent to gross domestic product per capita in 2020 in Taiwan (USD $30,038), continued treatment with denosumab in postmenopausal women with osteoporosis is cost-effective compared with treatment discontinuation.
本研究评估了与单次用药后停药相比，继续使用地舒单抗治疗台湾绝经后骨质疏松症的成本效果，使用了真实世界的骨折减少效果和成本数据。结果表明，继续使用地舒单抗治疗的增量成本效果比为每 QALY16743 美元。
目的
使用真实世界的骨折减少效果和成本数据，评估与单次用药后停药相比，继续使用地舒单抗治疗台湾绝经后骨质疏松症的成本效果。
方法
使用马尔可夫队列模型评估继续使用地舒单抗治疗与单次用药后停药治疗的终生成本和 QALY。评估从台湾医疗保健系统的角度进行，并采用每年 3%的贴现率。患者人群为平均年龄为 77 岁的开始接受地舒单抗治疗的骨质疏松绝经后妇女。骨折减少效果数据、基线骨折率、死亡率数据和骨折成本来自台湾全民健康保险研究数据库。
结果
模型结果表明，与单次用药后停药相比，继续使用地舒单抗治疗可预期获得 0.042 个 QALY 增益和 704 美元的增量成本。这相当于每获得一个 QALY 的增量成本效果比为 16743 美元。概率和情景分析表明，结果在模型假设和参数变化时是稳定的。
结论
在真实世界环境中，在地舒单抗治疗绝经后骨质疏松症妇女的成本效果比单次用药后停药更具成本效益，达到了 2020 年台湾人均国内生产总值（30038 美元）的成本效果阈值。
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