Cost-effectiveness of buffered soluble alendronate 70 mg effervescent tablet for the treatment of postmenopausal women with osteoporosis in Italy

Abstract

The use of buffered soluble alendronate 70 mg effervescent tablet, a convenient dosing regimen for bisphosphonate therapy, seems a cost-effective strategy compared with relevant alternative treatments for postmenopausal women with osteoporosis aged 60 years and over in Italy. Introduction To assess the cost-effectiveness of buffered soluble alendronate (ALN) 70 mg effervescent tablet compared with relevant alternative treatments for postmenopausal osteoporotic women in Italy. Methods A previously validated Markov microsimulation model was adjusted to the Italian healthcare setting to estimate the lifetime costs (expressed in €2019) per quality-adjusted life-years (QALY) of buffered soluble ALN compared with generic ALN, denosumab, zoledronic acid and no treatment. Pooled efficacy data derived from the NICE network meta-analysis were used for bisphosphonate treatments. Two treatment duration scenarios were assessed: 1 year using persistence data derived from an Italian prospective observational study including 144 and 216 postmenopausal osteoporotic women on buffered soluble ALN and oral ALN, respectively, and 3 years. Analyses were conducted for women 60-80 years of age with a bone mineral density Tscore ≤ − 3.0 or with existing vertebral fractures. Results In all simulated populations, buffered soluble ALN was dominant (more QALYs, lower costs) compared to denosumab. The cost per QALY gained of buffered soluble ALN compared to generic ALN and no treatment always falls below €20,000 per QALY gained. In the 1-year treatment scenario, zoledronic acid was associated with more QALY than buffered soluble ALN but the cost per QALY gained of zoledronic acid compared with buffered soluble ALN was always higher than €70,000, while buffered soluble ALN was dominant in the 3-year treatment scenario. Conclusion This study suggests that buffered soluble ALN represents a cost-effective strategy compared with relevant alternative treatments for postmenopausal osteoporosis women in Italy aged 60 years and over.

Novel formulations of oral bisphosphonates in the treatment of osteoporosis

“…The cost-effectiveness of effervescent alendronate was assessed using a Markov microsimulation model adjusted to the Italian healthcare system (using fracture data from 2017 discharge summaries) and incorporating the costs and consequences of fracture events over a lifetime of women up to the age of 100 years (or death) [ 70 ]. Effervescent alendronate was compared to alendronate, denosumab, zoledronate and no treatment.…”

“…Participants were aged 60–80 years and had T-scores ≤ − 3.0 or an existing vertebral fracture. Persistence data provided 12 months of follow-up with the model extended to 3 years to better reflect clinical practice [ 70 ].…”

“…In subgroup analyses, effervescent alendronate was dominant (indicating more QALYs for lower total costs) for cost-effectiveness over denosumab at 1 and 3 years for both low BMD and vertebral fracture groups, over alendronate at 1 and 3 years for the low BMD group ≥ 65 years and the fracture group ≥ 75 years and cost-saving compared to no treatment at 1 and 3 years for the low BMD group ≥ 65 years and the fracture group ≥ 75 years. Effervescent alendronate was dominant over zoledronate at 3 years but not at 1 year as it was assumed that persistence for zoledronate over 1 year would be 100% [ 70 ]. However, even at 1 year the ICER was below € 20,000 (€ 2019) per QALY.…”

Cost-Effectiveness Analysis of CT-Based Finite Element Modeling for Osteoporosis Screening in Secondary Fracture Prevention: An Early Health Technology Assessment in the Netherlands

“…In recent years, several cost-effectiveness studies have been conducted for osteoporosis screening (DXA and ultrasound) and treatment strategies. 66,[74][75][76][77] However, compared to Markov cohort models, we adopted a 2-dimensional, discrete-state simulation methodology that offered 2 main benefits: first, the large number of total iterations (parameter-level number multiplied by individual-level number) produced stable grand averaged lifetime costs and QALYs, on which we performed our CUAs. Second, the 2-dimensional structure allowed us to assess the effect on the model output of both the uncertainty surrounding input parameter point estimates and patient-level stochasticity, which was expressed by CEACs.…”

A model-based cost-effectiveness analysis of fracture liaison services in China

“…However, different assumptions were made in different studies, and our study has several strengths in comparison with other studies on the cost-effectiveness of FLS. First, the simulation model was adapted according to a previous Markov microsimulation model [12], which has been validated and applied in several prior studies [13,32,41,57]. Second, in our model, patients in the FLS pathway distinguished attenders and non-attenders, which is in line with reality.…”