Cost-Effectiveness Analysis of Denosumab Compared to Bisphosphonates for Treating Post-Menopausal Osteoporosis in Greece

Purpose: Osteoporosis consists an increasing economic burden for healthcare systems worldwide. In addition to prevention strategies, pharmaceutical treatment to reduce the risk for osteoporotic fractures is gaining focus. Data about the cost effectiveness of anti- osteoportic treatments in Greece is missing. We performed a cost- effectiveness analysis of the two golden standard treatment strategies, bisphosphonates and monoclonal antibodies, such as denosumab. Methods: Clinical data and data of bone absorptiometry of 128 post-menopausal women, who received antiosteoporotic treatment, were retrospectively collected. Based on this data a cost- effectiveness analysis was performed. As an indicator of effectiveness, we defined the patients’ transition, under anti- osteoporotic medication, into a condition in which all the criteria underlined by the Hellenic Osteoporosis Foundation as necessary to stop antiosteoporotic treatment are met. The costs included in the analysis involve the pharmaceutical costs, cost of the diagnostic procedure and cost of treatment of incident osteoporotic fractures. The two treatment regimens were compared by the incremental cost- effectiveness ratio (ICER). Results and conclusions: Treatment with denosumab is found to have statistical significantly higher efficiency (ΟR 2.58; 95%CIs 1.21-5.50; p=0.016) but also significantly higher treatment costs (2412.00 € ± 123.50 and 1760.00 € ± 141.3; p=0.0007) compared to treatment with bisphosphonates. Treatment with denosumab, is not cost-effective compared to bisphosphonate treatment (ICER 3105 €) for accomplishing the treatment objectives. In order to achieve cost effectiveness, the cost per unit of denosumab should be discounted by 30% or the adherence to treatment should significantly be increased.