Document Detail


Cost-effectiveness of denosumab in the treatment of postmenopausal osteoporosis in Canada.
MedLine Citation:
PMID:  23035625     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Denosumab is a novel biologic agent approved in Canada for treatment of post-menopausal osteoporosis (PMO) in women at high risk for fracture or who have failed or are intolerant to other osteoporosis therapies. This study estimated cost-effectiveness of denosumab vs usual care from the perspective of the Ontario public payer.
METHODS: A previously published PMO Markov cohort model was adapted for Canada to estimate cost-effectiveness of denosumab. The primary analysis included women with demographic characteristics similar to those from the pivotal phase III denosumab PMO trial (FREEDOM; age 72 years, femoral neck BMD T-score -2.16 SD, vertebral fracture prevalence 23.6%). Three additional scenario sub-groups were examined including women: (1) at high fracture risk, defined in FREEDOM as having at least two of three risk factors (age 70+; T-score ≤ -3.0 SD at lumbar spine, total hip, or femoral neck; prevalent vertebral fracture); (2) age 75+; and (3) intolerant or contraindicated to oral bisphosphonates (BPs). Analyses were conducted over a lifetime horizon comparing denosumab to usual care ('no therapy', alendronate, risedronate, or raloxifene [sub-group 3 only]). The analysis considered treatment-specific persistence and post-discontinuation residual efficacy, as well as treatment-specific adverse events. Both deterministic and probabilistic sensitivity analyses were conducted.
RESULTS: The multi-therapy comparisons resulted in incremental cost-effectiveness ratios for denosumab vs alendronate of $60,266 (2010 CDN$) (primary analysis) and $27,287 per quality-adjusted life year gained for scenario sub-group 1. Denosumab dominated all therapies in the remaining scenarios.
LIMITATIONS: Key limitations include a lack of long-term, real-world, Canadian data on persistence with denosumab as well as an absence of head-to-head clinical data, leaving one to rely on meta-analyses based on trials comparing treatment to placebo.
CONCLUSIONS: Denosumab may be cost-effective compared to oral PMO treatments for women at high risk of fractures and those who are intolerant and/or contraindicated to oral BPs.
Authors:
D Chau; D L Becker; M E Coombes; G Ioannidis; J D Adachi; R Goeree
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-10-16
Journal Detail:
Title:  Journal of medical economics     Volume:  15 Suppl 1     ISSN:  1941-837X     ISO Abbreviation:  J Med Econ     Publication Date:  2012  
Date Detail:
Created Date:  2012-11-20     Completed Date:  2013-05-10     Revised Date:  2013-06-03    
Medline Journal Info:
Nlm Unique ID:  9892255     Medline TA:  J Med Econ     Country:  England    
Other Details:
Languages:  eng     Pagination:  3-14     Citation Subset:  IM    
Affiliation:
Amgen Canada Inc, Mississauga, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Alendronate / economics,  therapeutic use
Antibodies, Monoclonal, Humanized / economics*,  therapeutic use
Bone Density Conservation Agents / economics,  therapeutic use
Cohort Studies
Cost-Benefit Analysis
Etidronic Acid / analogs & derivatives,  economics,  therapeutic use
Female
Humans
Markov Chains
Middle Aged
Models, Econometric
Ontario
Osteoporosis, Postmenopausal / drug therapy*
Quality-Adjusted Life Years
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal, Humanized; 0/Bone Density Conservation Agents; 105462-24-6/risedronic acid; 2809-21-4/Etidronic Acid; 4EQZ6YO2HI/denosumab; 66376-36-1/Alendronate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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