Cost Effectiveness of Denosumab versus Oral Bisphosphonates for Postmenopausal Osteoporosis in the US

Abstract

In each PMO population examined, denosumab represented good value for money compared with branded bisphosphonates. Furthermore, denosumab was either cost effective or dominant compared with generic alendronate in the high-risk subgroups.

Indirect comparison of teriparatide, denosumab, and oral bisphosphonates for the prevention of vertebral and nonvertebral fractures in postmenopausal women with osteoporosis

“…2,3 Vertebral and nonvertebral fractures are associated with substantial mortality and healthcare costs. 4,5 The most common interventions for the treatment of osteoporosis and the prevention of fractures are oral bisphosphonates (eg, alendronate, etidronate, ibandronate, and risedronate). Teriparatide is a skeletal anabolic drug approved for use in postmenopausal women with osteoporosis who are at high risk for fracture.…”

Cost-Effectiveness of Osteoporosis Screening Using Biomechanical Computed Tomography for Patients With a Previous Abdominal CT

“…For any patients who were treated, we assumed a nominal first course of treatment of generic alendronate (70 mg weekly), with an annual wholesale acquisition cost of $100 . For the cost of care for all types of fractures that would be prevented by the osteoporosis drug treatment, we modeled an effective total care cost of $50,000 per hip fracture during the year each hip fracture occurs plus $12,000 in the following year for additional care at home or in a nursing home . We did not account for the costs of any additional clinical program staff, which we assumed could be justified (and paid for) by any cost savings and would be similar for BCT and usual care.…”

“…We assumed QALY values for the no fracture state of 0.84 for women and 0.87 for men. Disutility values for the first and subsequent years after hip fracture were obtained using multipliers of 0.797 and 0.899, respectively ( Table 1 (1,5,7,10,11,17,25,26,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) ). As noted above, these parameter values are conservative because we did not consider QALY gains associated with preventing any other major osteoporotic fractures (e.g.…”

“…$100 Centers for Medicare & Medicaid Services (39) Hip fracture care First year after fracture $50,000 Hiligsman and colleagues (40) ; Nayak and Greenspan (7) ; Parthan and colleagues (41) ; Schousboe (5) ; Majumdar and colleagues (42) ; Kilgore and colleagues (43) Second year after fracture $12,000…”

“…Utility weights 0.84 (W) Fryback and colleagues (46) 0.87 (M) Disutility multiplier for hip fracture First year after fracture 0.797 Hiligsman and colleagues (40) ; Nayak and Greenspan (7) ; Parthan and colleagues (41) Following years 0.899…”