Cost Effectiveness of Teriparatide for Postmenopausal Osteoporosis: A Systematic Review.

Abstract

Background: Postmenopausal osteoporosis is a major public health concern, imposing a substantial economic burden on healthcare systems. Teriparatide is one of the key pharmacological treatments; however, its cost effectiveness remains controversial.

Objective: This systematic review aimed to evaluate the cost effectiveness of teriparatide in the treatment of postmenopausal women with osteoporosis.

Methods: A comprehensive literature search was conducted in PubMed, Scopus, Embase, and Web of Science up to October 2024. The included studies comprised cost-effectiveness and cost-utility analyses conducted from healthcare system/payer and societal perspectives. Studies that met the inclusion criteria were assessed using the Quality of Health Economic Studies (QHES) checklist.

Results: A total of 22 economic evaluations were included. Most studies found that teriparatide was not cost effective under general conditions, except in specific scenarios such as reduced drug prices, the use of generic alternatives, or under sensitivity analysis assumptions. The variability in willingness-to-pay thresholds and regional drug costs contributed substantially to differing incremental cost-effectiveness ratio outcomes across countries. Only a few studies accounted for indirect costs, and the limited geographic distribution highlighted the need for research in underrepresented regions such as the Middle East and Africa. Furthermore, a funding disclosure analysis suggested a potential bias in industry-sponsored studies, although no definitive conclusions could be drawn.

Conclusions: Our findings suggest that teriparatide is generally not cost effective for the treatment of postmenopausal osteoporosis, although its economic value may vary depending on contextual and policy-related factors. Further robust economic evaluations are needed, incorporating both direct and indirect costs, and covering understudied regions. The findings of this review can support informed resource allocation and policy making in osteoporosis management. Limitations include heterogeneity across the included studies, potential language bias due to the inclusion of only English-language publications, and methodological variations that limited cross-study comparability.