Skip to main content

Advertisement

SpringerLink
Log in

Cost-effectiveness of Denosumab for the Treatment of Postmenopausal Osteoporosis in Malaysia

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

From the perspective of Malaysian health care providers, denosumab was cost-effective in the treatment of postmenopausal osteoporosis, with an optimal outcome starting at age 60 years. Our results provide important insights into the value for money of anti-osteoporotic agents that can serve as a reference for other countries with comparable epidemiological data.

Introduction

The study aimed to compare the cost-effectiveness of denosumab with alendronate and no treatment in the management of postmenopausal osteoporosis among the Malaysian population.

Methods

A well-validated Markov model was used to estimate the cost-effectiveness of denosumab in a hypothetical cohort of postmenopausal osteoporotic women between 50 and 80 years old who had no history of fractures. A 10-year time horizon from the perspective of Malaysian health care providers was used in this analysis. The model parameters, including transition probabilities and costs, were based on Malaysian sources. Treatment efficacy data were obtained from a network meta-analysis. The study outcomes were presented as incremental cost per quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed to ensure the robustness of the results. A cost-effectiveness threshold was set at MYR 21,438 (USD 5175) per QALY.

Results

Denosumab was found to be a cost-effective option for postmenopausal osteoporotic women aged 60 and older. The incremental cost-effectiveness ratios (ICERs) for denosumab versus alendronate ranged from MYR 16,955 (USD 4093) per QALY at age 60 to MYR 4380 (USD 1057) per QALY at age 80. The cost-effectiveness of denosumab improved monotonically with increasing age. Denosumab was 72.8–92.7% likely to be cost-effective at the cost-effectiveness threshold. Sensitivity analyses demonstrated that the results were robust across all parameter variations, with the annual cost of denosumab being the most sensitive.

Conclusions

From the perspective of the Malaysian health care provider, denosumab appears to be a cost-effective treatment choice for postmenopausal osteoporotic women over 60 years of age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Odén A, McCloskey EV, Kanis JA et al (2015) Burden of high fracture probability worldwide: secular increases 2010–2040. Osteoporos Int 26:2243–2248. https://doi.org/10.1007/s00198-015-3154-6

    Article  PubMed  Google Scholar 

  2. Department of Statistics Malaysia (2016) Population Projection (Revised), Malaysia, 2010–2040. Malaysia

  3. Cheung C-L, Bin AS, Chadha M et al (2018) An updated hip fracture projection in Asia: The Asian Federation of Osteoporosis Societies study. Osteoporos Sarcopenia 4:16–21. https://doi.org/10.1016/j.afos.2018.03.003

    Article  PubMed  PubMed Central  Google Scholar 

  4. Pharmaceutical Services Programme (2021) Official Portal of Pharmaceutical Services Programme, Ministry of Health Malaysia. https://www.pharmacy.gov.my/v2/en. Accessed 21 Apr 2021

  5. Fatoye F, Smith P, Gebrye T, Yeowell G (2019) Real-world persistence and adherence with oral bisphosphonates for osteoporosis: a systematic review. BMJ Open 9:e027049. https://doi.org/10.1136/bmjopen-2018-027049

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Cornelissen D, Boonen A, Bours S et al (2020) Understanding patients’ preferences for osteoporosis treatment: the impact of patients’ characteristics on subgroups and latent classes. Osteoporos Int 31:85–96. https://doi.org/10.1007/s00198-019-05154-9

    Article  CAS  PubMed  Google Scholar 

  7. Zhu Y, Huang Z, Wang Y et al (2020) The efficacy and safety of denosumab in postmenopausal women with osteoporosis previously treated with bisphosphonates: a review. J Orthop Transl 22:7–13. https://doi.org/10.1016/j.jot.2019.08.004

    Article  Google Scholar 

  8. Chau D, Becker DL, Coombes ME et al (2012) Cost-effectiveness of denosumab in the treatment of postmenopausal osteoporosis in Canada. J Med Econ 15:3–14. https://doi.org/10.3111/13696998.2012.737393

    Article  PubMed  Google Scholar 

  9. Darbà J, Kaskens L, Vilela FS, Lothgren M (2015) Cost-utility of denosumab for the treatment of postmenopausal osteoporosis in Spain. Clin Outcomes Res 7:105–117. https://doi.org/10.2147/CEOR.S78349

    Article  Google Scholar 

  10. Hiligsmann M, Reginster JY (2011) Cost effectiveness of denosumab compared with oral bisphosphonates in the treatment of post-menopausal osteoporotic women in Belgium. Pharmacoeconomics 29:895–911. https://doi.org/10.2165/11539980-000000000-00000

    Article  PubMed  Google Scholar 

  11. Jönsson B, Ström O, Eisman JA et al (2011) Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis. Osteoporos Int 22:967–982. https://doi.org/10.1007/s00198-010-1424-x

    Article  PubMed  Google Scholar 

  12. Mori T, Crandall CJ, Ganz DA (2017) Cost-effectiveness of denosumab versus oral alendronate for elderly osteoporotic women in Japan. Osteoporos Int 28:1733–1744. https://doi.org/10.1007/s00198-017-3940-4

    Article  CAS  PubMed  Google Scholar 

  13. Parthan A, Kruse M, Yurgin N et al (2013) Cost effectiveness of denosumab versus oral bisphosphonates for postmenopausal osteoporosis in the US. Appl Health Econ Health Policy 11:485–497. https://doi.org/10.1007/s40258-013-0047-8

    Article  PubMed  Google Scholar 

  14. Yoshizawa T, Nishino T, Okubo I, Yamazaki M (2018) Cost-effectiveness analysis of drugs for osteoporosis treatment in elderly Japanese women at high risk of fragility fractures: comparison of denosumab and weekly alendronate. Arch Osteoporos 13:94. https://doi.org/10.1007/s11657-018-0509-6

    Article  PubMed  Google Scholar 

  15. Karnon J, Shafie AS, Orji N, Usman SK (2016) What are we paying for? A cost-effectiveness analysis of patented denosumab and generic alendronate for postmenopausal osteoporotic women in Australia. Cost Eff Resour Alloc 14:11. https://doi.org/10.1186/s12962-016-0060-5

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pongchaiyakul C, Nanagara R, Songpatanasilp T, Unnanuntana A (2020) Cost-effectiveness of denosumab for high-risk postmenopausal women with osteoporosis in Thailand. J Med Econ 23:776–785. https://doi.org/10.1080/13696998.2020.1730381

    Article  PubMed  Google Scholar 

  17. Zethraeus N, Borgström F, Ström O et al (2007) Cost-effectiveness of the treatment and prevention of osteoporosis - a review of the literature and a reference model. Osteoporos Int 18:9–23. https://doi.org/10.1007/s00198-006-0257-0

    Article  CAS  PubMed  Google Scholar 

  18. Ministry of Health Malaysia (2015) Clinical Guidance on Management of Osteoporosis, Second edi. Ministry of Health Malaysia, Malaysia

  19. Ministry of Health Malaysia (2019) Pharmacoeconomic Guidelines for Malaysia, Second edi. Ministry of Health Malaysia, Malaysia

  20. World Health Organization, Baltussen, Rob M. P. M, Adam, Taghreed, Tan-Torres Edejer, Tessa, Hutubessy, Raymond CW et al (‎2003)‎ Making choices in health: WHO guide to cost-effectiveness analysis / edited by T. Tan-Torres Edejer ... [‎et al]‎. Geneva: World Health Organization

  21. Hiligsmann M, Reginster JY, Tosteson ANA et al (2019) Recommendations for the conduct of economic evaluations in osteoporosis: outcomes of an experts’ consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and. Osteoporos Int 30:45–57. https://doi.org/10.1007/s00198-018-4744-x

    Article  CAS  PubMed  Google Scholar 

  22. Husereau D, Drummond M, Augustovski F et al (2022) Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: updated reporting guidance for health economic evaluations. Pharmacoeconomics 2022https://doi.org/10.1007/s40273-021-01112-8

  23. Medical Development Division (2021) Malaysian DRG Executive Information System. In: Minist. Heal. Malaysia. http://casemix-eis.moh.gov.my/. Accessed 1 Feb 2021

  24. Klotzbuecher CM, Ross PD, Landsman PB et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739. https://doi.org/10.1359/jbmr.2000.15.4.721

    Article  CAS  PubMed  Google Scholar 

  25. Fleurence RL, Hollenbeak CS (2007) Rates and probabilities in economic modelling: Transformation, translation and appropriate application. Pharmacoeconomics 25:3–6. https://doi.org/10.2165/00019053-200725010-00002

    Article  PubMed  Google Scholar 

  26. Department of Statistics Malaysia (2020) Vital Statistics, Malaysia, 2020. Malaysia

  27. Chang CY, Tang CH, Chen KC et al (2016) The mortality and direct medical costs of osteoporotic fractures among postmenopausal women in Taiwan. Osteoporos Int 27:665–676. https://doi.org/10.1007/s00198-015-3238-3

    Article  PubMed  Google Scholar 

  28. Ha YC, Kim TY, Lee A et al (2016) Current trends and future projections of hip fracture in South Korea using nationwide claims data. Osteoporos Int 27:2603–2609. https://doi.org/10.1007/s00198-016-3576-9

    Article  PubMed  Google Scholar 

  29. Kwon GD, Jang S, Lee A et al (2016) Incidence and mortality after distal radius fractures in adults aged 50 years and older in Korea. J Korean Med Sci 31:630–634. https://doi.org/10.3346/jkms.2016.31.4.630

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Kim TY, Jang S, Park CM et al (2016) Trends of incidence, mortality, and future projection of spinal fractures in Korea using nationwide claims data. J Korean Med Sci 31:801–805. https://doi.org/10.3346/jkms.2016.31.5.801

    Article  PubMed  PubMed Central  Google Scholar 

  31. Li S, Sun T, Liu Z (2016) Excess mortality of 1 year in elderly hip fracture patients compared with the general population in Beijing, China. Arch Osteoporos 11:35. https://doi.org/10.1007/s11657-016-0289-9

    Article  PubMed  Google Scholar 

  32. Man LP, Angela Ho AWH, Wong SH (2016) Excess mortality for operated geriatric hip fracture in Hong Kong. Hong Kong Med J 22:6–10. https://doi.org/10.12809/hkmj154568

  33. Kanis JA, Oden A, Johnell O et al (2003) The components of excess mortality after hip fracture. Bone 32:468–473. https://doi.org/10.1016/S8756-3282(03)00061-9

    Article  CAS  PubMed  Google Scholar 

  34. Kanis JA, Oden A, Johnell O et al (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112. https://doi.org/10.1007/s00198-003-1516-y

    Article  PubMed  Google Scholar 

  35. Barrionuevo P, Kapoor E, Asi N et al (2019) Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: a network meta-analysis. J Clin Endocrinol Metab 104:1623–1630. https://doi.org/10.1210/jc.2019-00192

    Article  PubMed  Google Scholar 

  36. Ström O, Borgström F, Kanis JA, Jönsson B (2009) Incorporating adherence into health economic modelling of osteoporosis. Osteoporos Int 20:23–34. https://doi.org/10.1007/s00198-008-0644-9

    Article  PubMed  Google Scholar 

  37. Reyes C, Tebe C, Martinez-Laguna D et al (2017) One and two-year persistence with different anti-osteoporosis medications: a retrospective cohort study. Osteoporos Int 28:2997–3004. https://doi.org/10.1007/s00198-017-4144-7

    Article  CAS  PubMed  Google Scholar 

  38. Hadji P, Kyvernitakis I, Kann PH et al (2016) GRAND-4: the German retrospective analysis of long-term persistence in women with osteoporosis treated with bisphosphonates or denosumab. Osteoporos Int 27:2967–2978. https://doi.org/10.1007/s00198-016-3623-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Cheng LI, Durden E, Limone B et al (2015) Persistence and compliance with osteoporosis therapies among women in a commercially insured population in the United States. J Manag Care Pharm 21:824–833. https://doi.org/10.18553/jmcp.2015.21.9.824

  40. Durden E, Pinto L, Lopez-Gonzalez L et al (2017) Two-year persistence and compliance with osteoporosis therapies among postmenopausal women in a commercially insured population in the United States. Arch Osteoporos 12:22. https://doi.org/10.1007/s11657-017-0316-5

    Article  PubMed  PubMed Central  Google Scholar 

  41. Lakatos P, Takács I, Marton I et al (2016) A retrospective longitudinal database study of persistence and compliance with treatment of osteoporosis in Hungary. Calcif Tissue Int 98:215–225. https://doi.org/10.1007/s00223-015-0082-6

    Article  CAS  PubMed  Google Scholar 

  42. Morley J, Moayyeri A, Ali L et al (2020) Persistence and compliance with osteoporosis therapies among postmenopausal women in the UK Clinical Practice Research Datalink. Osteoporos Int 31:533–545. https://doi.org/10.1007/s00198-019-05228-8

    Article  CAS  PubMed  Google Scholar 

  43. Miyazaki T, Tokimura F, Tanaka S (2014) A review of denosumab for the treatment of osteoporosis. Patient Prefer Adherence 8:463–471. https://doi.org/10.2147/PPA.S46192

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bone HG, Hosking D, Devogelaer J-P et al (2004) Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 350:1189–1199. https://doi.org/10.1056/nejmoa030897

    Article  CAS  PubMed  Google Scholar 

  45. Black DM, Schwartz AV, Ensrud KE et al (2006) Effects of continuing or stopping alendronate after 5 years of treatment: The Fracture Intervention Trial long-term extension (FLEX): a randomized trial. J Am Med Assoc 296:2927–2938. https://doi.org/10.1001/jama.296.24.2927

    Article  CAS  Google Scholar 

  46. McClung MR, Wagman RB, Miller PD et al (2017) Observations following discontinuation of long-term denosumab therapy. Osteoporos Int 28:1723–1732. https://doi.org/10.1007/s00198-017-3919-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Kendler DL, McClung MR, Freemantle N et al (2011) Adherence, preference, and satisfaction of postmenopausal women taking denosumab or alendronate. Osteoporos Int 22:1725–1735. https://doi.org/10.1007/s00198-010-1378-z

    Article  CAS  PubMed  Google Scholar 

  48. Brown JP, Prince RL, Deal C et al (2009) Comparison of the effect of denosumab and alendronate on BMD and biochemical markers of bone turnover in postmenopausal women with low bone mass: a randomized, blinded, phase 3 trial. J Bone Miner Res 24:153–161. https://doi.org/10.1359/jbmr.0809010

    Article  CAS  PubMed  Google Scholar 

  49. World Bank Group (2021) GDP deflator (base year varies by country) - Malaysia. https://data.worldbank.org/indicator/NY.GDP.DEFL.ZS?end=2019&locations=MY&start=2010. Accessed 15 Feb 2021

  50. Central Bank of Malaysia (2021) Exchange Rates 2019. https://www.bnm.gov.my/exchange-rates. Accessed 1 Mar 2021

  51. Federal Government Gazette (2014) Fees (Medical) (Cost of Services) Order 2014. Attorney General’s Chambers, Malaysia

    Google Scholar 

  52. Ara R, Brazier JE (2011) Using health state utility values from the general population to approximate baselines in decision analytic models when condition-specific data are not available. Value Heal 14:539–545. https://doi.org/10.1016/j.jval.2010.10.029

    Article  Google Scholar 

  53. Si L, Winzenberg TM, De Graaff B, Palmer AJ (2014) A systematic review and meta-analysis of utility-based quality of life for osteoporosis-related conditions. Osteoporos Int 25:1987–1997. https://doi.org/10.1007/s00198-014-2636-2

    Article  CAS  PubMed  Google Scholar 

  54. Lim YW, Shafie AA, Chua GN, Ahmad Hassali MA (2017) Determination of cost-effectiveness threshold for health care interventions in Malaysia. Value Heal 20:1131–1138. https://doi.org/10.1016/j.jval.2017.04.002

    Article  Google Scholar 

  55. Briggs A, Sculpher M, Claxton K (2006) Decision modelling for health economic evaluation. Oxford University Press

    Google Scholar 

Download references

Funding

This study was funded by the Geran Galakan Penyelidik Muda (grant number GGPM-2019–054).

Author information

Authors and Affiliations

  1. Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia

    Y. W. Choo, N. A. Mohd Tahir & M. Makmor Bakry

  2. Pharmacy Department, Kuala Lipis Hospital, Ministry of Health Malaysia, 27200, Kuala Lipis , Pahang, Malaysia

    Y. W. Choo

  3. Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Cheras, Malaysia

    M. S. Mohamed Said

  4. School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, 2308, Australia

    S. C. Li

Authors
  1. Y. W. Choo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. A. Mohd Tahir
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. S. Mohamed Said
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. C. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Makmor Bakry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. A. Mohd Tahir.

Ethics declarations

Conflict of interest

YWC, MSMS, MMB, SCL, and NAMT declare that they have no conflict of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choo, Y.W., Mohd Tahir, N.A., Mohamed Said, M.S. et al. Cost-effectiveness of Denosumab for the Treatment of Postmenopausal Osteoporosis in Malaysia. Osteoporos Int 33, 1909–1923 (2022). https://doi.org/10.1007/s00198-022-06444-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-022-06444-5

Keywords

Search

Navigation