Diaz Martinez Juan Pablo, Aubry de Maraumont Therese, Natty Sánchez Elly, Camacho Cordero Luis Miguel, Yeh Eric
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Health Economics Amgen Mexico, Mexico City, Mexico.
PLoS One. 2025 Feb 7;20(2):e0299673. doi: 10.1371/journal.pone.0299673. eCollection 2025.
This study aims to assess the cost effectiveness of romosozumab versus teriparatide, both sequenced to denosumab, for the treatment of severe postmenopausal osteoporosis at very high risk of fractures in Mexican women.
A Markov model was used to assess the relative cost effectiveness of 1 year of romosozumab versus 2 years of teriparatide, both sequenced to denosumab for a total treatment duration of 5 years. Outcomes for a cohort of women with a mean age of 74 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 Mexican healthcare system and used a discount rate of 5% 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 (2023 Mexican pesos), quality-adjusted life years (QALYs) and life-years gained (LYs).
Base case results showed that, compared with teriparatide/ denosumab, romosozumab/ denosumab reduced costs by $51,363 MXN per patient and yielded 0.03 additional QALYs and 0.01 LYs. Scenario analyses and probabilistic sensitivity analyses confirmed that results are robust to uncertainty in model assumptions and inputs.
Results show that romosozumab/ denosumab produces greater health benefits at a lower total cost than teriparatide/ denosumab.
本研究旨在评估在墨西哥女性中，罗莫佐单抗与特立帕肽序贯地诺单抗治疗骨折极高风险的严重绝经后骨质疏松症的成本效益。
采用马尔可夫模型评估1年罗莫佐单抗与2年特立帕肽序贯地诺单抗共5年治疗期的相对成本效益。对平均年龄74岁、T值≤ -2.5且有既往脆性骨折的女性队列进行终身模拟。分析从墨西哥医疗系统角度进行，使用每年5%的贴现率。为了得出相对骨折发生率，利用骨质疏松症治疗试验的meta回归提供的关系，将罗莫佐单抗相对于特立帕肽的骨密度（BMD）优势转化为相对骨折风险。结果根据终身成本（2023年墨西哥比索）、质量调整生命年（QALYs）和获得的生命年（LYs）进行评估。
基础病例结果显示，与特立帕肽/地诺单抗相比，罗莫佐单抗/地诺单抗每位患者成本降低51363墨西哥比索，产生额外0.03个QALYs和0.01个LYs。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/地诺单抗相比，罗莫佐单抗/地诺单抗以更低的总成本产生更大的健康效益。
