Cost-effectiveness intervention thresholds for romosozumab and teriparatide in the treatment of osteoporosis in the UK.

IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Osteoporosis International Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI:10.1007/s00198-024-07251-w
Fredrik Borgström, Mattias Lorentzon, Helena Johansson, Nicholas C Harvey, Eugene McCloskey, Damon Willems, Douglas Knutsson, John A Kanis
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引用次数: 0

Abstract

Sequential romosozumab-to-alendronate or sequential teriparatide-to-alendronate can be a cost-effective treatment option for postmenopausal women at very high risk of fracture.

Purpose: To estimate the 10-year probability of a major osteoporotic fracture (MOF) at which sequential treatment with romosozumab or teriparatide followed by alendronate, compared with alendronate alone, becomes cost-effective in a UK setting.

Methods: A microsimulation model with a Markov structure was used to simulate fractures, costs, and quality-adjusted life years (QALYs), in women receiving sequential treatment with either romosozumab or teriparatide followed by alendronate, compared with alendronate alone. Patients aged 50 to 90 years with a recent MOF, hip or spine fracture were followed from the start of a 5-year treatment until the age of 100 years or death. The analysis had a healthcare perspective. Efficacy of romosozumab, teriparatide and alendronate was derived from phase III randomised controlled trials. Resource use and unit costs were derived from the literature. Cost-effectiveness intervention threshold (CEIT), defined as the 10-year probability of a major osteoporotic fracture at which treatment becomes cost-effective, was compared with clinically appropriate intervention thresholds for bone-forming treatment in women with very high fracture risk as recommended by the UK National Osteoporosis Guideline Group (NOGG).

Results: The base case analysis showed that sequential romosozumab-to-alendronate treatment was cost-effective from a 10-year MOF probability of 18-35% and above depending on age and site of sentinel fracture at a willingness to pay (WTP) of £30,000. For teriparatide-to-alendronate, treatment was cost-effective at a 10-year MOF probability of 27-57%. The results were sensitive to pricing of the drugs but relatively insensitive to treatment duration, romosozumab persistence assumptions, and site of sentinel fracture. The CEITs for romosozumab-to-alendronate treatment were lower than the clinical thresholds from the age of 70 years meaning that treatment could be considered both cost-effective and aligned with the NOGG treatment guidelines. By contrast, for teriparatide-to-alendronate the CEITs were higher than the clinical thresholds irrespective of age. However, cost-effective scenarios were found in the presence of strong clinical risk factors in addition to a recent sentinel fracture.

Conclusion: The results of this study indicate that sequential romosozumab-to-alendronate or teriparatide-to-alendronate treatment can be a cost-effective treatment option for postmenopausal women at very high risk of fracture.

英国罗莫索单抗和特立帕肽治疗骨质疏松症的成本效益干预阈值。
罗莫索单抗-阿仑膦酸钠序贯治疗或特立帕肽-阿仑膦酸钠序贯治疗对于骨折风险极高的绝经后妇女来说是一种具有成本效益的治疗方案。目的:在英国环境下,估算发生重大骨质疏松性骨折(MOF)的10年概率,与单独使用阿仑膦酸钠相比,在发生重大骨质疏松性骨折(MOF)时,罗莫索单抗或特立帕肽-阿仑膦酸钠序贯治疗具有成本效益:采用马尔可夫结构的微观模拟模型模拟了接受罗莫单抗或特立帕肽和阿仑膦酸钠序贯治疗的女性患者的骨折情况、成本和质量调整生命年(QALYs),并与单用阿仑膦酸钠进行比较。研究人员对年龄在 50 至 90 岁之间、近期发生过 MOF、髋部或脊柱骨折的患者进行了为期 5 年的随访,直至患者 100 岁或死亡。分析从医疗保健角度进行。罗莫单抗、特立帕肽和阿仑膦酸钠的疗效来自于III期随机对照试验。资源使用和单位成本来自文献。将成本效益干预阈值(CEIT)与英国国家骨质疏松症指南小组(NOGG)推荐的针对骨折风险极高的女性进行成骨治疗的临床适当干预阈值进行了比较:基础病例分析表明,根据年龄和前哨骨折部位的不同,在10年MOF概率为18%-35%及以上的情况下,罗莫单抗-阿仑膦酸钠序贯治疗的成本效益为30,000英镑。对于特立帕肽对阿仑膦酸钠,10 年 MOF 概率为 27-57%时,治疗具有成本效益。结果对药物定价很敏感,但对治疗时间、罗莫索单抗持续性假设和前哨骨折部位相对不敏感。罗莫单抗对阿仑膦酸钠治疗的CEITs低于70岁以上的临床阈值,这意味着治疗既具有成本效益,又符合NOGG治疗指南。相比之下,对于特立帕肽对阿仑膦酸盐的治疗,无论年龄大小,CEIT 都高于临床阈值。然而,在存在较强的临床风险因素以及近期发生过前哨骨折的情况下,也能发现具有成本效益的方案:本研究结果表明,对于骨折风险极高的绝经后妇女来说,罗莫单抗-阿仑膦酸钠或特立帕肽-阿仑膦酸钠序贯治疗是一种具有成本效益的治疗方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Osteoporosis International
Osteoporosis International 医学-内分泌学与代谢
CiteScore
8.10
自引率
10.00%
发文量
224
审稿时长
3 months
期刊介绍: An international multi-disciplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA, Osteoporosis International provides a forum for the communication and exchange of current ideas concerning the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases. It publishes: original papers - reporting progress and results in all areas of osteoporosis and its related fields; review articles - reflecting the present state of knowledge in special areas of summarizing limited themes in which discussion has led to clearly defined conclusions; educational articles - giving information on the progress of a topic of particular interest; case reports - of uncommon or interesting presentations of the condition. While focusing on clinical research, the Journal will also accept submissions on more basic aspects of research, where they are considered by the editors to be relevant to the human disease spectrum.
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