Diphosphonates; Bone Density Conservation Agents; Male; Female; Humans; Middle Aged; Aged; Cost-Effectiveness Analysis; Diphosphonates/therapeutic use; Cost-Benefit Analysis; Osteoporosis, Postmenopausal/drug therapy; Osteoporosis/diagnosis; Osteoporosis/drug therapy; Osteoporotic Fractures/prevention & control; Bone Density Conservation Agents/therapeutic use; Pharmacology; Health Policy; Public Health, Environmental and Occupational Health
Abstract :
[en] [en] BACKGROUND: Osteoporosis is often considered to be a disease of women. Over the last few years, owing to the increasing clinical and economic burden, the awareness and imperative for identifying and managing osteoporosis in men have increased substantially. With the approval of agents to treat men with osteoporosis, more economic evaluations have been conducted to assess the potential economic benefits of these interventions. Despite this concern, there is no specific overview of cost-effectiveness analyses for the treatment of osteoporosis in men.
OBJECTIVES: This study aims (1) to systematically review economic evaluations of interventions for osteoporosis in men; (2) to critically appraise the quality of included studies and the source of model input data; and (3) to investigate the comparability of results for studies including both men and women.
METHODS: A literature search mainly using MEDLINE (via Ovid) and Embase databases was undertaken to identify original articles published between 1 January, 2000 and 30 June, 2022. Studies that assessed the cost effectiveness of interventions for osteoporosis in men were included. The Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases and the International Osteoporosis Foundation osteoporosis-specific guideline was used to assess the quality of design, conduct, and reporting of included studies.
RESULTS: Of 2973 articles identified, 25 studies fulfilled the inclusion criteria, classified into economic evaluations of active drugs (n = 8) or nutritional supplements (n = 4), intervention thresholds (n = 5), screening strategies (n = 6), and post-fracture care programs (n = 2). Most studies were conducted in European countries (n = 15), followed by North America (n = 9). Bisphosphonates (namely alendronate) and nutritional supplements were shown to be generally cost effective compared with no treatment in men over 60 years of age with osteoporosis or prior fractures. Two other studies suggested that denosumab was cost effective in men aged 75 years and older with osteoporosis compared with bisphosphates and teriparatide. Intervention thresholds at which bisphosphonates were found to be cost effective varied among studies with a 10-year probability of a major osteoporotic fracture that ranged from 8.9 to 34.2% for different age categories. A few studies suggested cost effectiveness of screening strategies and post-fracture care programs in men. Similar findings regarding the cost effectiveness of drugs and intervention thresholds in women and men were captured, with slightly greater incremental cost-effectiveness ratios in men. The quality of the studies included had an average score of 18.8 out of 25 (range 13-23.5). Hip fracture incidence and mortality risk were mainly derived from studies in men, while fracture cost, treatment efficacy, and disutility were commonly derived from studies in women or studies combining both sexes.
CONCLUSIONS: Anti-osteoporosis drugs and nutritional supplements are generally cost effective in men with osteoporosis. Screening strategies and post-fracture care programs also showed economic benefits for men. Cost-effectiveness and intervention thresholds were generally similar in studies conducted in both men and women, with slightly greater incremental cost-effectiveness ratios in men.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Li, Nannan; Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
Beaudart, Charlotte ; Centre Hospitalier Universitaire de Liège - CHU > > Service de médecine de l'appareil locomoteur ; Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands ; WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
Cauley, Jane A; Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
Ing, Steven W; Division of Endocrinology, Diabetes and Metabolism, Ohio State University Wexner Medical Center, Columbus, OH, USA
Lane, Nancy E; Department of Medicine, University of California at Davis, School of Medicine, Sacramento, CA, USA
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique ; WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
Silverman, Stuart; Cedars-Sinai Medical Center, Los Angeles, CA, USA ; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
Singer, Andrea J; Departments of Obstetrics and Gynecology and Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
Hiligsmann, Mickaël ; Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. m.hiligsmann@maastrichtuniversity.nl
Language :
English
Title :
Cost Effectiveness Analyses of Interventions for Osteoporosis in Men: A Systematic Literature Review.
This study is sponsored by Radius Health, Inc.Nannan Li is funded by the China Scholarship Council (grant number 201909110080). Mickaël Hiligsmann has received research grants through his institution from Amgen, Radius Health, Inc. (Radius), and ViiV, consulting fees from UCB, and lecture fees from Mylan Pharmaceuticals. Stuart Silverman has received grants from Amgen and Radius, and has received consulting fees from Amgen and Radius. Steven W. Ing has received research grants paid to his institution from Alexion, Amgen, Calcilytix, Radius, Takeda, and Ultragenyx. Andrea Singer has received research grants paid to her institution from Radius and UCB, consulting fees from Agnovos, Amgen, Radius, and UCB, and speaking fees from Amgen and Radius. Charlotte Beaudart, Jean-Yves Reginster, Nancy E. Lane, and Jane A, Cauley have no conflicts of interest that are directly relevant to the content of this article.
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