NDnex, Saebitgongwon-ro 67, Gwangmyeong-si, Gyeonggi-do, 14348, Republic of Korea.
Amgen Korea Ltd, Seoul, Republic of Korea.
BMC Musculoskelet Disord. 2024 Jan 20;25(1):76. doi: 10.1186/s12891-024-07185-8.
Insurance reimbursement provisions in South Korea limit osteoporosis medication availability for patients with T-scores exceeding - 2.5. This study aimed to evaluate the financial impact and fracture prevention of continuous denosumab therapy until a T-score>-2.0 (Dmab-C strategy), versus discontinuation of denosumab after reaching T-score>-2.5 (Dmab-D strategy) in osteoporosis patients.
A cost-consequence analysis from a Korean healthcare system perspective was performed using a newly developed Markov model. The incidence of vertebral and non-vertebral fracture, fracture-related deaths, drug costs, and fracture-treatment costs were estimated and compared between Dmab-C and Dmab-D strategy over a lifetime in eligible patients aged 55 years.
Base-case analysis revealed that Dmab-C prevented 32.21 vertebral fracture (VF) and 12.43 non-VF events per 100 patients over a lifetime, while reducing 1.29 fracture-related deaths. Lifetime direct healthcare cost saving per patient was KRW 1,354,655 if Dmab-C replaces Dmab-D. When productivity losses were considered, Dmab-C saved KRW 29,025,949 per patient compared to Dmab-D. The additional treatment costs of Dmab-C could be offset by the higher subsequent treatment costs and fracture treatment costs of Dmab-D. The sensitivity analysis showed consistent patterns with results of the base-case analysis.
Continuous treatment using denosumab until osteoporosis patients achieve and maintain a T-score of -2.0 would provide greater clinical and economic benefits in terms of fracture prevention and reduced mortality risks compared to outcomes from discontinuing treatment at a T-score of -2.5 or above. This new treatment strategy would effectively lower the risk of fractures and fracture-related mortality, ultimately leading to lower medical expenses.
韩国的保险报销条款限制了 T 评分超过-2.5 的骨质疏松症患者获得骨质疏松症药物的机会。本研究旨在评估在骨质疏松症患者 T 评分>-2.0 时继续使用地舒单抗治疗（Dmab-C 策略）与在达到 T 评分>-2.5 时停止使用地舒单抗（Dmab-D 策略）对财务影响和骨折预防的影响。
从韩国医疗保健系统的角度，使用新开发的马尔可夫模型进行成本-后果分析。在符合条件的 55 岁患者中，估计并比较了 Dmab-C 和 Dmab-D 策略在一生中发生椎体和非椎体骨折、骨折相关死亡、药物成本和骨折治疗成本的情况。
基础案例分析表明，Dmab-C 可预防 32.21 例椎体骨折（VF）和 12.43 例非 VF 事件，每 100 例患者终生发生一次，同时减少 1.29 例骨折相关死亡。如果 Dmab-C 替代 Dmab-D，则每位患者终生节省直接医疗保健成本 1354655 韩元。如果考虑到生产力损失，Dmab-C 比 Dmab-D 为每位患者节省 29025949 韩元。Dmab-C 的额外治疗成本可以通过更高的后续治疗成本和 Dmab-D 的骨折治疗成本来抵消。敏感性分析显示与基础案例分析结果一致。
与在 T 评分-2.5 或更高时停止治疗相比，使用地舒单抗连续治疗直到骨质疏松症患者达到并维持 T 评分-2.0 将在预防骨折和降低死亡率方面提供更大的临床和经济效益。这种新的治疗策略可以有效地降低骨折和骨折相关死亡率的风险，最终降低医疗费用。
