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Economic evaluation of four treatment strategies for postmenopausal patients with osteoporosis and a recent fracture in mainland China: a cost-effectiveness analysis

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Abstract

Summary

Postmenopausal patients with osteoporosis who have a recent fracture are at very high risk of fracture, and this study finds that stratified treatment based on fracture risk would be a cost-effective treatment option for this population.

Purpose

To evaluate the cost-effectiveness of four anti-osteoporosis medications (denosumab, zoledronate, teriparatide, and alendronate) for postmenopausal osteoporotic women in mainland China, using a stratified treatment strategy recommended by the American Association of Clinical Endocrinologists and the American College of Endocrinology (AACE/ACE).

Methods

A microsimulation Markov model was used to compare the cost-effectiveness of the four treatments in postmenopausal osteoporotic patients of different ages (65, 70, 75, and 80 years), with a recent fracture from the Chinese healthcare perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represent the incremental cost per quality-adjusted life-year (QALY) obtained. One-way deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were performed to assess the robustness of model findings.

Results

Alendronate was dominated by denosumab-to-alendronate and zoledronate at all ages examined, indicating that the costs of the two drugs were lower, but QALYs was greater. However, teriparatide-to-alendronate yielded an ICER of $76,432.07/ QALY, compared with alendronate at age 65, which exceeded the pre-determined willingness-to-pay threshold of $37,653/ QALY. The results were similar at other ages. The DSA showed that the most sensitive parameters were drug efficacy for vertebral and wrist fractures, the relative risk of vertebral fractures, and the persistence of the drugs. The PSA showed that zoledronate had a 100% probability of being the most cost-effective treatment, with a willingness-to-pay threshold of $37,653/ QALY.

Conclusion

Stratified treatment based on very high fracture risk is more cost-effective than conventional pills in mainland China. Among the stratified treatments, zoledronate is the optimal option.

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Availability of data and materials

Detailed model inputs and results are available from this article and its supplementary information files. Other data will be available from the corresponding author on reasonable request.

Funding

This work was supported by grants from the National Natural Science Foundation of China [81870622], the Hunan Provincial Natural Science Foundation of China [2022JJ30828], the Changsha Municipal Natural Science Foundation [kq2014251], Hunan Provincial Innovation Foundation for Postgraduate [CX20210372], the Fundamental Research Funds for the Central Universities of Central South University [506021749 and 512191022], Degree& Postgraduate Education Reform Project of Central South University [512190112], Scientific Research Project of Hunan Provincial Health Commission [C202303067096 and 202112070631], Central Subsidy for Prevention and Control of Major Infectious Diseases and HANS CARING Inc. The source of funding for the study played role in the design and conduct of the study, data collection, analysis, interpretation, and manuscript writing.

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Author notes

  1. Lin Tian and Chuo Luo contributed equally to this work.

Authors and Affiliations

  1. Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, 410011, China

    Lin Tian, Chuo Luo, Yong-Fang Li, Qin-Yi Wang, Xiao-Li Qu, Chun Yue & Zhi-Feng Sheng

  2. Health Management Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China

    Lu-Lu Xu & Yan-Yi Yang

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  1. Lin Tian
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Contributions

LT and CL designed the study, collected the data, analyzed the data, visualized the data, interpreted the results, and wrote the manuscript. YL contributed to the study design, data collection, data analysis, and interpretation of results. QW, XQ, CY, LX, and YY provided input into the study design, data collection, and interpretation of results. ZS designed the study, interpreted the results, and supervised the whole study. All coauthors contributed to revisions of the manuscript. LT and CL contributed equally as the co-first authors.

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Correspondence to Zhi-Feng Sheng.

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Tian, L., Luo, C., Li, YF. et al. Economic evaluation of four treatment strategies for postmenopausal patients with osteoporosis and a recent fracture in mainland China: a cost-effectiveness analysis. Arch Osteoporos 18, 100 (2023). https://doi.org/10.1007/s11657-023-01309-8

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