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Comparative cost-effectiveness of bazedoxifene and raloxifene in the treatment of postmenopausal osteoporosis in Europe, using the FRAX algorithm

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Abstract

Summary

Bazedoxifene and raloxifene were evaluated in the treatment of postmenopausal osteoporosis from health economic perspective in Europe. Based on a computer-based algorithm calculating efficacy of the treatments, bazedoxifene appears to be a cost-effective strategy compared to raloxifene, particularly in patients at high fracture risk.

Introduction

The purpose of this study was to compare cost-effectiveness of bazedoxifene and raloxifene in eight European countries: Belgium, France, Germany, Ireland, Italy, Spain, Sweden, and the UK.

Methods

The Fracture Risk Assessment Tool, which is a computer-based algorithm to calculate fracture probability using clinical risk factors alone or with bone mineral density, was incorporated in a Markov Tunnel model to evaluate cost-effectiveness of bazedoxifene 20 or 40 mg vs. raloxifene 60 mg in postmenopausal osteoporotic women. The efficacy of bazedoxifene and raloxifene for vertebral and non-vertebral fractures was measured as a function of the 10-year probability of a major osteoporotic fracture. The model estimated the incremental cost-effectiveness ratio and net monetary benefit (NMB) from a healthcare perspective, given the willingness to pay €30,000.

Results

In postmenopausal osteoporotic women, bazedoxifene was a cost saving strategy compared to raloxifene in the countries studied. The median NMB of bazedoxifene compared to raloxifene increased monotonically with the 10-year fracture probability. In general, the median NMB became greater than 0 in women with 10-year probabilities of a major osteoporotic fracture between 5 and 10 % or above. The impact on results by varying the assumptions in the model was examined in sensitivity analysis.

Conclusion

Bazedoxifene appears to be a cost-effective strategy compared to raloxifene for the treatment of postmenopausal osteoporotic women in Europe, particularly in patients at high fracture risk.

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Acknowledgments

This study was sponsored by Pfizer. Kun Kim and Axel Svedbom are employees of OptumInsight, who were paid consultants to Pfizer in connection with the development of this manuscript. The economic modeling and validation work was performed at OptumInsight, and OptumInsight is also responsible for the data storage.

Conflicts of interest

Xuemei Luo is an employee of Pfizer, and Santosh Sutradhar was an employee of Pfizer at the time this work was conducted. As employees of OptumInsight, Kun Kim and Axel Svedbom have provided consultancy services to numerous companies involved in the marketing of treatment for osteoporosis.

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Authors and Affiliations

  1. OptumInsight, Klarabergsviadukten 90, Hus D, 11164, Stockholm, Sweden

    K. Kim & A. Svedbom

  2. Unit of Dermatology; Department of Medicine, Karolinska Institutet, Solna, Sweden

    A. Svedbom

  3. Pfizer, Inc., Groton, CT, USA

    X. Luo

  4. Pfizer, New York, NY, USA

    S. Sutradhar

  5. University of Sheffield Medical School, Sheffield, UK

    J. A. Kanis

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  1. K. Kim
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Correspondence to K. Kim.

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Santosh Sutradhar is no longer affiliated with Pfizer, Inc.

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Kim, K., Svedbom, A., Luo, X. et al. Comparative cost-effectiveness of bazedoxifene and raloxifene in the treatment of postmenopausal osteoporosis in Europe, using the FRAX algorithm. Osteoporos Int 25, 325–337 (2014). https://doi.org/10.1007/s00198-013-2521-4

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