Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, Health Management Center, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China.
Department of Pharmacy, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410011, Hunan, People's Republic of China.
J Endocrinol Invest. 2023 Feb;46(2):367-379. doi: 10.1007/s40618-022-01910-7. Epub 2022 Aug 31.
Five strategies were recommended by the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) guidelines for the treatment of postmenopausal osteoporosis (PMO) patients with a very high fracture risk. We aimed to assess their cost-effectiveness in the United States (US).
A microsimulation Markov model was created to compare the cost-effectiveness of five treatment strategies, including zoledronate, denosumab, abaloparatide, teriparatide, and romosozumab in PMO patients with a recent fracture from the healthcare perspective of the US. The data used in the model were obtained from published studies or online resources. Base-case analysis, one-way deterministic sensitivity analysis (DSA) and probability sensitivity analysis (PSA) were conducted for 65-, 70-, 75-, and 80-year-old patients.
In base case, at 65 years, zoledronate was the cheapest strategy. The incremental cost-effectiveness ratios (ICER, which represent incremental costs per QALY gained) of denosumab, teriparatide, abaloparatide, and romosozumab against zoledronate were $13,020/QALY (quality-adjusted years), $477,331 /QALY, $176,287/QALY, and $98,953/QALY, respectively. Under a willing-to-pay (WTP, which means the highest price a consumer will pay for one unit of a good of service) threshold of $150,000/QALY, denosumab and romosozumab were cost-effective against zoledronate. The PSA results showed that denosumab was the most cost-effective option with WTP thresholds of $50,000/QALY, $100,000/QALY and $150,000/QALY. The results were similar in other age groups. The DSA results indicated that the most common parameters that have important influence on the outcome were drug persistence, incidence of adverse events, the efficacy of drugs on hip fractures and the cost of the drug.
Among PMO patients with a very high fracture risk in the US, zoledronate is the cheapest strategy and denosumab is the most cost-effective choice among these five strategies.
美国临床内分泌医师协会/美国内分泌学会（AACE/ACE）指南推荐了 5 种策略，用于治疗具有极高骨折风险的绝经后骨质疏松症（PMO）患者。我们旨在评估这些策略在美国的成本效益。
我们创建了一个微观模拟马尔可夫模型，以比较唑来膦酸、地舒单抗、abaloparatide、特立帕肽和 romosozumab 这 5 种治疗方案在具有近期骨折的 PMO 患者中的成本效益，从美国医疗保健的角度来看。模型中使用的数据来自已发表的研究或在线资源。对 65 岁、70 岁、75 岁和 80 岁的患者进行了基础案例分析、单因素确定性敏感性分析（DSA）和概率敏感性分析（PSA）。
在基础案例中，唑来膦酸在 65 岁时是最便宜的策略。与唑来膦酸相比，地舒单抗、特立帕肽、abaloparatide 和 romosozumab 的增量成本效益比（ICER，代表每获得一个质量调整生命年的增量成本）分别为 13020 美元/QALY（质量调整生命年）、477331 美元/QALY、176287 美元/QALY 和 98953 美元/QALY。在支付意愿（WTP，即消费者愿意为一种商品或服务支付的最高价格）阈值为 150000 美元/QALY 的情况下，地舒单抗和 romosozumab 对唑来膦酸具有成本效益。PSA 结果表明，在支付意愿阈值为 50000 美元/QALY、100000 美元/QALY 和 150000 美元/QALY 的情况下，地舒单抗是最具成本效益的选择。在其他年龄组中也得到了类似的结果。DSA 结果表明，对结果影响最大的最常见参数是药物持久性、不良事件发生率、药物对髋部骨折的疗效和药物成本。
在美国具有极高骨折风险的 PMO 患者中，唑来膦酸是最便宜的策略，而在地舒单抗、特立帕肽、abaloparatide 和 romosozumab 这 5 种策略中，地舒单抗是最具成本效益的选择。
