PMS27 The Cost-Effectiveness of Denosumab for the Prevention of Osteoporotic Fractures in the Setting of the United States

Abstract

males, 10% and 7% were children and females respectively. Majority of the males (79%) were between the ages of 15-35 years of age. On an average the direct cost incurred to treat the injured cases (103) was PKR13,000 excluding subsidy of at least PKR53,000. The total cost was PKR66,000 (USD805) and this cost shall be considered as minimum cost. CONCLUSIONS: Motorcycle accidents are incurring huge economic burden on society. The morbidity and mortality can be reduced by legislative action concerning helmet use, licensing and rigid enforcement of traffic laws. Rehabilitation services for the victims to get fully recovered may also be provided to reduce the future economic loss. OBJECTIVES:Orthopedic surgery has been associated with significant risk of develop deep vein thrombosis (DVT). The objective of this study was to estimate the cost-effectiveness of thromboprophylaxis therapies for prevention of DVT associated in patients undergoing hip surgery from an institutional perspective (Mexican Social Security Institute, IMSS). METHODS: Economic and health consequences of thromboprophylaxis were assessed through a six-state Markov model (one-year time horizon, one-week cycles). Effectiveness measure was reduction in DVT (per 1000 patients). Effectiveness was estimated by local meta-analysis. Doses of alternatives compared were: warfarin (basecase, 5mg 30d); dalteparin (not listed in Mexican formulary, 5000 IU/day 30d); acenocoumarol (4 mg/day 30d); enoxaparin (40 mg/day 30d); nadroparin (5700 IU/day 30d) and unfractionated heparin (UFH) plus warfarin (10000 IU/day 10dϩwarfarin 5 mg/day 20d). No prophylaxis was assessed too. Resource use and unit costs were extracted from IMSS databases (dalteparin cost was provided by the manufacturer). Costs included outpatient and inpatient services, medication costs, imaging and laboratory tests. Univariate sensitivity analysis was performed. Acceptability curves were constructed. RESULTS: DVT cases per alternative were: warfarin 61 (CI 95% 60 -62); dalteparin 33 (32-34); acenocoumarol 80 (78 -82); enoxaparin 57 (56 -58); nadroparin 67 (66 -68);

Denosumab: A Unique Perspective on Adherence and Cost-effectiveness Compared With Oral Bisphosphonates in Osteoporosis Patients

“…34 A more comprehensive societal perspective was taken among 4 studies. 31,33,39,42 Five of 8 scenarios taking the societal perspective estimated ICERs <$100 000 per QALY, including 2 scenarios where use of denosumab was found to be cost saving among elderly people older than 75 years in Japan. 39 Other studies utilized the health system perspective, 32,36,40 health care sector perspective, 39 or governmental perspective, 39 representing 45 scenarios.…”

“…34,40,41 This relationship was further supported in 4 articles, which found that treatment with denosumab was more cost-effective among high-risk patients, individuals with more hip fractures, and patients with more CRFs. 14,34,38,42 Overall, 13 studies across 65 scenarios examined ICERs with some percentage of patients having fractures, where use of denosumab was found to be cost-effective <$100 000 per QALY gained in 78% of scenarios (n = 51), including 7 scenarios where it was cost saving. 14,29,38,40 In studies in Belgium, Japan, and Spain, use of denosumab was found to be <$50 000 per QALY gained even among individuals with no previous fractures.…”

“…The initial search for cost-effectiveness of denosumab yielded 40 articles, among which we identified 12 articles and 3 abstracts that compared the cost-effectiveness of denosumab with that of generic alendronate (Table 1). 14,[29][30][31][32][33][34][35][36][37][38][39][40][41][42] Included studies were conducted across 10 high-income countries. The majority of studies (n = 11) focused solely on the use of denosumab for osteoporosis in women, whereas 2 studies investigated use in men 29,30 and 2 other studies considered both genders.…”

“…32,36,38 The annual cost (2017 US dollars) of denosumab ranged from $420.81 in Australia 36 to $1761.62 in the United States, 14 which was always higher than the cost of generic alendronate, which ranged from $25.11 in Sweden 33 to $400.44 in Canada. 38 Only 2 studies reported having no conflicts of interest, 39,42 whereas 7 studies included industry authors. 14,29,30,35,37,38,40 Combined, these articles provided 104 ICERs across scenarios varying perspectives and patient characteristics such as previous fracture experiences, BMD T-scores, and age categories (Table 2).…”

“…Six studies compared ICERs by the prevalence of vertebral fractures, previous fractures, hip fractures, or number of CRFs. 14,34,38,[40][41][42] Three articles showed that use of denosumab was more cost-effective among individuals with previous fractures compared with no previous fractures, even among individuals of the same age group. 34,40,41 This relationship was further supported in 4 articles, which found that treatment with denosumab was more cost-effective among high-risk patients, individuals with more hip fractures, and patients with more CRFs.…”