Public Health, Environmental and Occupational Health; Health Policy; Pharmacology; Sequential treatment; abaloparatide; alendronate; high risk of fractures men
Abstract :
[en] [en] BACKGROUND AND OBJECTIVES: Abaloparatide (ABL) significantly increases bone mineral density in men with osteoporosis similar to what was reported in postmenopausal women with osteoporosis. The cost effectiveness of sequential treatment with ABL followed by alendronate (ALN) in men at high fracture risk was compared to relevant alternative treatments.
METHODS: A Markov-based microsimulation model based on a lifetime US healthcare decision maker perspective was developed to evaluate the cost (expressed in US$2021) per quality-adjusted life-years (QALYs) gained of sequential ABL/ALN. Comparators were sequential treatment unbranded teriparatide (TPTD)/ALN, generic ALN monotherapy, and no treatment. Discount rates of 3% were used. Consistent with practice guidelines, patients received 18 months of ABL or TPTD followed by ALN for 5 years, or 5 years of ALN monotherapy. Analyses were conducted in high-risk men aged over 50 years defined as having a bone mineral density T-score ≤-2.5 and a recent fracture. Time-specific risk of subsequent fracture after a recent fracture, incremental costs up to 5 years following fractures, real-world medication adherence, and mostly US men-specific data were included in the model. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of results.
RESULTS: Over the full age range, sequential ABL/ALN led to more QALYs for lower costs than sequential unbranded TPTD/ALN, while no treatment was dominated (more QALYs, lower costs) by ALN monotherapy. The costs per QALY gained of sequential ABL/ALN were lower than the US threshold of US$150,000 versus generic ALN monotherapy. The probabilities that sequential ABL/ALN was cost effective compared to ALN monotherapy were estimated at 51% in men aged 50 years and between 88 and 90% in those aged ≥ 60 years.
CONCLUSIONS: Sequential therapy using ABL/ALN may be cost effective compared with generic ALN monotherapy in US men aged ≥ 50 years at high fracture risk, especially in those aged ≥ 60 years. Unbranded TPTD/ALN and no treatment were dominated interventions (less QALY, more costs) compared with ABL/ALN or ALN monotherapy.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Hiligsmann, Mickaël ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé ; Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. m.hiligsmann@maastrichtuniversity.nl
Silverman, Stuart S; Cedars-Sinai Medical Center, Los Angeles and the OMC Clinical Research Center, Beverly Hills, CA, USA
Singer, Andrea J; MedStar Georgetown University Hospital and Georgetown University Medical Center, Washington, DC, USA
Pearman, Leny; Radius Health, Inc., Boston, MA, USA
Mathew, Jake; Radius Health, Inc., Boston, MA, USA
Wang, Yamei; Radius Health, Inc., Boston, MA, USA
Caminis, John; Radius Health, Inc., Boston, MA, USA
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique ; Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
Language :
English
Title :
Cost-Effectiveness of Sequential Abaloparatide/Alendronate in Men at High Risk of Fractures in the United States.
Publication date :
22 April 2023
Journal title :
PharmacoEconomics
ISSN :
1170-7690
eISSN :
1179-2027
Publisher :
Springer Science and Business Media LLC, New Zealand
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