Osteoporosis International

, Volume 17, Issue 2, pp 201–211 | Cite as

Economic evaluation of parathyroid hormone (PTH) in the treatment of osteoporosis in postmenopausal women

Original Article

Abstract

Parathyroid hormone (PTH) is a new treatment for osteoporosis and has been shown to reduce the risks of vertebral and non-vertebral fractures in postmenopausal women in clinical trials. The objective of this study was to estimate the cost-effectiveness of teriparatide in addition to calcium and vitamin D, using a simulation model. The base case analysis was conducted for a cohort of 69-year-old women in Sweden who had at least one previous vertebral fracture and low bone mineral density. The model simulated the course of events in 6-month cycles in individual patients until death or 100 years of age. During each cycle the patients were at risk of experiencing clinical vertebral, hip or wrist fractures, or death. Total accumulated life-time costs and quality-adjusted life years (QALYs) were estimated. Swedish data on fracture costs, utility reductions after fracture, fracture risks and mortality rates were used. The model incorporated new epidemiological evidence that indicates fracture risks and mortality rates are higher in the subsequent years post-fracture. The results showed that the cost-effectiveness of the treatment is highly dependant on the risk profile of the treated patients and the timing of starting treatment relative to previous fractures. The cost per QALY gained for treatment of a population of 69-year-olds with a T-score at the femoral neck of −3 was in the base case estimated to be between EUR (€) 20,000 and 64,000 for patients with a recent or historic vertebral fracture respectively. The study provides further evidence of the benefit and cost-effectiveness of starting osteoporotic treatments early in patients with a new fracture, and also that teriparatide may provide valuable clinical benefits for these patients and may be considered a cost-effective intervention when targeted to the appropriate patients.

Keywords

Cost effectiveness Cost utility Fracture Osteoporosis Parathyroid hormone 

Notes

Acknowledgements

The study was conducted with financial support from Lilly Europe.

References

  1. 1.
    Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795Google Scholar
  2. 2.
    Melton LJ 3rd (1993) Hip fractures: a worldwide problem today and tomorrow. Bone 14 [Suppl 1]:S1–8Google Scholar
  3. 3.
    Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, et al (2000) Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab 85:4118–4124Google Scholar
  4. 4.
    McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340Google Scholar
  5. 5.
    Body JJ, Gaich GA, Scheele WH, Kulkarni PM, Miller PD, Peretz A, et al (2002) A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1–34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 87:4528–4535Google Scholar
  6. 6.
    Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441.Google Scholar
  7. 7.
    Lindsay R, Scheele W, Clancy A, Mitlak B (2001) Incident vertebral fractures during an 18-month observation period following discontinuation of ly333334 [recombinant human parathyroid hormone (1–34), rhPTH (1–34] use in postmenopausal women with osteoporosis. J Bone Min Res 16 [Suppl 1]:S163Google Scholar
  8. 8.
    Lindsay R, Scheele W, Clancy A, Mitlak B (2001) Maintenance of reduction in nonvertebral fragility fractures 18 months after discontinuation of recombinant human parathyroid hormode (1–34) use in postmenopausal women with osteoporosis. Osteoprosos Int 12 [Suppl 2]:S46Google Scholar
  9. 9.
    Marcus R, Wang O, Satterwhite J, Mitlak B (2003) The skeletal response to teriparatide is largely independent of age, initial bone mineral density, and prevalent vertebral fractures in postmenopausal women with osteoporosis. J Bone Miner Res 18:18–23Google Scholar
  10. 10.
    Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, et al (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15:175–179Google Scholar
  11. 11.
    Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, et al (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42Google Scholar
  12. 12.
    Zethraeus N, Ben Sedrine W, Caulin F, Corcaud S, Gathon HJ, Haim M, et al (2002) Models for assessing the cost-effectiveness of the treatment and prevention of osteoporosis. Osteoporos Int 13:841–857Google Scholar
  13. 13.
    Johnell O, Jonsson B, Jonsson L, Black D (2003) Cost effectiveness of alendronate (fosamax) for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics 21:305–314Google Scholar
  14. 14.
    Jonsson B, Christiansen C, Johnell O, Hedbrandt J (1995) Cost-effectiveness of fracture prevention in established osteoporosis. Osteoporos Int 5:136–142Google Scholar
  15. 15.
    Zethraeus N, Johannesson M, Jonsson B (1999) A computer model to analyze the cost-effectiveness of hormone replacement therapy. Int J Technol Assess Health Care 15:352–365Google Scholar
  16. 16.
    Zethraeus N, Jönsson B, Lindgren P (2000) A computer model to analyze the cost-effectiveness of hormone replacement therapy—a revised version. Stockholm: Economic Research Insitute (EFI)Google Scholar
  17. 17.
    Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, et al (2000) Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 11:669–674Google Scholar
  18. 18.
    Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259Google Scholar
  19. 19.
    Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A (2000) Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 27:585–590Google Scholar
  20. 20.
    Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828Google Scholar
  21. 21.
    Kanis J, Brazier J, Stevenson M, Calvert N, Lloyd Jones M (2002) Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technology Assessment, NHS R&D HTA program 6 (29)Google Scholar
  22. 22.
    Kanis JA, Johnell O, Oden A, Jonsson B, Dawson A, Dere W (2000) Risk of hip fracture derived from relative risks: an analysis applied to the population of Sweden. Osteoporos Int 11:120–127Google Scholar
  23. 23.
    (2003) Statistics Sweden. Sweden’s Statistical DatabasesGoogle Scholar
  24. 24.
    Browner WS, Pressman AR, Nevitt MC, Cummings SR (1996) Mortality following fractures in older women. The study of osteoporotic fractures. Arch Intern Med 156:1521–1525Google Scholar
  25. 25.
    Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473Google Scholar
  26. 26.
    Zethraeus N, Stromberg L, Jonsson B, Svensson O, Ohlen G (1997) The cost of a hip fracture. Estimates for 1,709 patients in Sweden. Acta Orthop Scand 68:13–17Google Scholar
  27. 27.
    Zethraeus N (2002) Costs and quality of life associated with osteoporosis related fractures—based on a Swedish pilot study. Stockholm: Centre for Health Economics (Stockholm School of Economics)Google Scholar
  28. 28.
    Jonsson B, Christiansen C, Johnell O, Hedbrandt J, Karlsson G (1996) Cost-effectiveness of fracture prevention in established osteoporosis. Scand J Rheumatol Suppl 103:30–38Google Scholar
  29. 29.
    (2000) Stadsledningenskontorets redovisningsstab. The municpality of Stockholm. Stockholm: Stockholms stads budgetavräkningGoogle Scholar
  30. 30.
    De Laet CE, van Hout BA, Burger H, Weel AE, Hofman A, Pols HA (1999) Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study. Osteoporos Int 10:66–72Google Scholar
  31. 31.
    LINFO (2003) FASS Läkemedel i Sverige (Swedish drug prices). Oslo, Läkemedelsinformation ABGoogle Scholar
  32. 32.
    Meltzer D (1997) Accounting for future costs in medical cost-effectiveness analysis. J Health Econ 16:33–64Google Scholar
  33. 33.
    Ekman M, Zethraeus N, Dahlstrom U, Hoglund C (2002) [Cost-effectiveness of bisoprolol in chronic heart failure]. Lakartidningen 99:646–650Google Scholar
  34. 34.
    Lundberg L (1999) Health-related quality of life in Sweden. Dissertation. Faculty of Pharmacy, Uppsala University, UppsalaGoogle Scholar
  35. 35.
    Hall SE, Criddle RA, Comito TL, Prince RL (1999) A case-control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture. Osteoporos Int 9:508–515Google Scholar
  36. 36.
    Tosteson AN, Gabriel SE, Grove MR, Moncur MM, Kneeland TS, Melton LJ 3rd (2001) Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int 12:1042–1049Google Scholar
  37. 37.
    Ekman M, Johnell O, Lidgren L (2004) The economic cost of low back pain in Sweden. Forthcoming in SpineGoogle Scholar
  38. 38.
    Ekman M, Jönhagen S, Hunsche E, Jönsson L (2004) Burden of illnesss of chronic low back pain in Sweden: a cross-sectional, retrospective study in primary care setting. Forthcoming in Acta Orthopaed ScandGoogle Scholar
  39. 39.
    Atlas SJ, Nardin RA (2003) Evaluation and treatment of low back pain: an evidence-based approach to clinical care. Muscle Nerve 27:265–284Google Scholar
  40. 40.
    Hollingworth W, Deyo RA, Sullivan SD, Emerson SS, Gray DT, Jarvik JG (2002) The practicality and validity of directly elicited and SF-36 derived health state preferences in patients with low back pain. Health Econ 11:71–85Google Scholar
  41. 41.
    Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427Google Scholar
  42. 42.
    Lothgren M, Zethraeus N (2000) Definition, interpretation and calculation of cost-effectiveness acceptability curves. Health Econ 9:623–630Google Scholar
  43. 43.
    Melton LJ, 3rd, Gabriel SE, Crowson CS, Tosteson AN, Johnell O, Kanis JA (2003) Cost-equivalence of different osteoporotic fractures. Osteoporos Int 14:383–388Google Scholar
  44. 44.
    Kanis JA, Johnell O, Oden A, De Laet C, Jonsson B, Dawson A (2002) Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies. Bone 30:251–258Google Scholar
  45. 45.
    Weinstein MC, O’Brien B, Hornberger J, Jackson J, Johannesson M, McCabe C, et al (2003) Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices—Modeling Studies. Value Health 6:9–17Google Scholar
  46. 46.
    Eichler HG, Kong SX, Gerth WC, Mavros P, Jonsson B (2004) Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge? Value Health 7:518–528Google Scholar
  47. 47.
    Ekman M (2002) Studies in health economics: EFI, Stockholm School of Economics, StockholmGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • J. Lundkvist
    • 1
    • 5
  • O. Johnell
    • 2
  • C. Cooper
    • 3
  • D. Sykes
    • 4
  1. 1.Medical Management CentreKarolinska InstitutetStockholmSweden
  2. 2.UMASDepartment of OrthopedicsMalmöSweden
  3. 3.Southampton General HospitalSouthamptonUK
  4. 4.UK Lilly Research CentreErl Wood ManorWindleshamUK
  5. 5.Stockholm Health EconomicsKlarabergsgatan 33StockholmSweden

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