Cost-effectiveness analysis of drugs for osteoporosis treatment in elderly Japanese women at high risk of fragility fractures: comparison of denosumab and weekly alendronate
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This study’s purpose was to clarify the cost-effectiveness of osteoporosis treatment. Denosumab treatment was cost-effective compared with alendronate treatment for elderly Japanese women at high risk of fragility fractures. Denosumab treatment might be cost-effective for patients with lower bone mineral density.
In Japan’s super-aged society, the prevention and treatment of osteoporosis are a critical issue with implications for the medical economy. This study’s purpose was to clarify the cost-effectiveness of osteoporosis treatment with denosumab versus weekly alendronate for elderly Japanese women at high risk of fragility fractures.
A Markov model was used for simulation analysis. The modeled population was 75-year-old Japanese women with a bone mineral density (BMD) of 65% of the young adult mean (YAM) (T-score, − 2.87) and a history of previous vertebral body fracture. The simulation model was repeated until patient age reached 100 years or death. Analysis was performed from the societal perspective. Costs and epidemiological data were derived from previous studies. The incremental cost-effectiveness ratio (ICER) was calculated from the simulation. We compared the ICER with willingness-to-pay. Additional analyses were performed with different combinations of age and BMD. Sensitivity analysis verified the robustness of the analysis.
For the modeled population, the ICER of denosumab versus alendronate treatment was estimated at US$40,241/quality-adjusted life year (QALY). The ICER of denosumab for 80-year-old women whose BMD was 60% of YAM was estimated at US$22,469/QALY.
Assuming willingness-to-pay as US$50,000/QALY, denosumab treatment for 75-year-old Japanese women with a BMD of 65% of YAM and a history of previous vertebral body fracture was cost-effective compared with alendronate treatment. Among over 75 years of age, denosumab treatment might be more cost-effective than alendronate for patients with a BMD of 65% of YAM or lower.
KeywordsOsteoporosis Cost-utility analysis Denosumab Alendronate Willingness-to-pay
We would like to express our greatest appreciation to Dr. Shu-Ling Hoshi, from the Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, for her useful discussion and idea regarding this work and to Rebecca Tollefson, DVM, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
Compliance with ethical standards
Conflicts of interest
This article does not contain any studies with human participants or animals performed by any of the authors.
- 2.Imai N, Endo N, Shobugawa Y, Ibuchi S, Suzuki H, Miyasaka D, Sakuma M (2017) A decrease in the number and incidence of osteoporotic hip fractures among elderly individuals in Niigata, Japan, from 2010 to 2015. J Bone Miner Metab. https://doi.org/10.1007/s00774-017-0863-2
- 6.Committee of Japanese Guidelines for the Prevention and Treatment of Osteoporosis (2015) The Japanese guidelines for the prevention and treatment of osteoporosis (2015 edn). Life Science Publishing, Tokyo. In JapaneseGoogle Scholar
- 8.Nagase T (2016) Market of osteoporosis treatment drugs. Kokusai Iyakuhin Jouhou 1072:6–14 In JapaneseGoogle Scholar
- 9.Murad MH, Drake MT, Mullan RJ, Mauck KF, Stuart LM, Lane MA, Abu Elnour NO, Erwin PJ, Hazem A, Puhan MA, Li T, Montori VM (2012) Clinical review. Comparative effectiveness of drug treatments to prevent fragility fractures: a systematic review and network meta-analysis. J Clin Endocrinol Metab 97:1871–−1880CrossRefGoogle Scholar
- 17.Japan Ministry of Health, Labour and Welfare (2018) Life table for Japanese. http://www.mhlw.go.jp/toukei/saikin/hw/life/22th/dl/22th_04.pdf. Accessed 31 Mar 2018
- 20.Boonen S, Adachi JD, Man Z, Cummings SR, Lippuner K, Törring O, Gallagher JC, Farrerons J, Wang A, Franchimont N, San Martin J, Grauer A, McClung M (2011) Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. J Clin Endocrinol Metab 96:1727–1736CrossRefGoogle Scholar
- 23.Bone HG, Bolognese MA, Yuen CK, Kendler DL, Miller PD, Yang YC, Grazette L, San Martin J, Gallagher JC (2011) Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab 96:972–980CrossRefGoogle Scholar
- 25.Hadji P, Papaioannou N, Gielen E, Feudjo Tepie M, Zhang E, Frieling I, Geusens P, Makras P, Resch H, Möller G, Kalouche-Khalil L, Fahrleitner-Pammer A (2015) Persistence, adherence, and medication-taking behavior in women with postmenopausal osteoporosis receiving denosumab in routine practice in Germany, Austria, Greece, and Belgium: 12-month results from a European non-interventional study. Osteoporos Int 26:2479–2−89CrossRefGoogle Scholar
- 26.National Health Insurance Drug List (2018) Jihou Press, Tokyo. In JapaneseGoogle Scholar
- 28.Konno S, Togawa D, Kamae I, Inoue Y, Kikuchi S (2009) Burden of illness of conservative medical management to vertebral compression fracture in Japanese osteoporosis patients. Orthop Surg 60:1022–1039 In JapaneseGoogle Scholar
- 29.Reward for Nursing Care (2015) Igaku-tsushin-sha, Tokyo, Japan. In JapaneseGoogle Scholar
- 33.Medical Fee Schedule (2016) Igaku-tsushin-sha, Tokyo, Japan. In JapaneseGoogle Scholar
- 34.University of Sheffield (2018) FRAX WHO Fracture Risk Assessment Tool. Japan. https://www.sheffield.ac.uk/FRAX/tool.aspx?country=3. Accessed 6 Aug 2018. In Japanese
- 35.Japan Ministry of Health, Labour and Welfare (2018) Average value of height / weight. https://www.mhlw.go.jp/toukei/youran/indexyk_2_1.html. Accessed 6 Aug 2018. In Japanese
- 38.Karnon J, Shafie AS, Orji N, Usman SK (2016) What are we paying for? A cost-effectiveness analysis of patented denosumab and generic alendronate for postmenopausal osteoporotic women in Australia. Cost Eff Resour Alloc 14(11)Google Scholar
- 42.Freemantle N, Satram-Hoang S, Tang ET, Kaur P, Macarios D, Siddhanti S, Borenstein J, Kendler DL (2012) Final results of the DAPS (Denosumab Adherence Preference Satisfaction) study: a 24-month, randomized, crossover comparison with alendronate in postmenopausal women. Osteoporos Int 23:317–326CrossRefGoogle Scholar
- 45.Japan Ministry of Health, Labour and Welfare (2018) the Central Social Insurance Medical Council, cost effectiveness assessment expert group meeting. https://www.mhlw.go.jp/file/05-Shingikai-12404000-Hokenkyoku-Iryouka/0000179573.pdf Accessed 31 Mar 2018. In Japanese