Abstract
Introduction
Strontium ranelate is a new therapy for the treatment and prevention of osteoporosis that has been shown in two phase III clinical trials (the Spinal Osteoporosis Therapeutic Intervention [SOTI] and the Treatment Of Peripheral OSteoporosis Study [TROPOS] trials) to reduce the risk of osteoporotic fractures at the vertebral, non-vertebral and hip level in postmenopausal women. The aim of this study was to estimate the potential cost-effectiveness of strontium ranelate in the treatment of osteoporosis in postmenopausal Swedish patients.
Methods
A Markov cohort model was adapted to fit patients corresponding to the patients in the SOTI and TROPOS clinical trials. The model was populated with Swedish cost and epidemiological data. In the base case, the cost-effectiveness was estimated for 69-year old women with low bone mineral density (BMD) and prevalent vertebral fractures (SOTI) and for 77-year old women with low BMD (TROPOS). The cost-effectiveness analysis had a societal perspective.
Results
In the base case analysis, the cost per quality-adjusted life years (QALY) gained of strontium ranelate patients compared to no treatment patients was estimated at SEK 472,586 and SEK 259,643, including costs in added life years, based on the SOTI and the TROPOS trials, respectively. Excluding cost in added life years, the cost per QALY gained was estimated at SEK 336,420 (SOTI) and SEK 165,680 (TROPOS). In subgroup analyses, in patients 74 years and older with a T-score lower than −2.4 and patients older than 80 years of age, strontium ranelate was found to be cost saving compared to no treatment.
Conclusions
The results in the base case analyses and the sensitivity analyses of this study indicate that, compared to no treatment, strontium ranelate is cost-effective in the treatment of postmenopausal women with low BMD.
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References
Meunier PJ, Roux C, Seeman E, Ortolani S, Badurski JE, Spector TD, Cannata J, Balogh A, Lemmel EM, Pors-Nielsen S, Rizzoli R, Genant HK, Reginster JY (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 350(5):459–468
Reginster JY, Seeman E, De Vernejoul MC, Adami S, Compston J, Phenekos C, Devogelaer JP, Curiel MD, Sawicki A, Goemaere S, Sorensen OH, Felsenberg D, Meunier PJ (2005) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. J Clin Endocrinol Metab 90(5):2816–2822
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(5):305–314
Borgstrom F, Zethraeus N (2003) Economic assessment based on a clinical study of risedronate. Fracture prevention in elderly women with osteoporosis is cost-effective. Lakartidningen 100(1–2):36–40
Borgstrom F, Johnell O, Jonsson B, Zethraeus N, Sen SS (2004) Cost effectiveness of alendronate for the treatment of male osteoporosis in Sweden. Bone 34(6):1064–1071
Jonsson L, Borgstrom F, Zethraeus N (2003) Cost-effectiveness of alendronate treatment of osteoporosis in Denmark. An economic evaluation based on the Fracture Intervention Trial. Ugeskr Laeger 165(43):4112–4116
Kanis JA, Borgstrom F, Johnell O, Jonsson B (2004) Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women. Osteoporos Int 15(11):862–871
Looker AC, Wahner HW, Dunn WL, Calvo MS, Harris TB, Heyse SP, Johnston CC Jr, Lindsay R (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8(5):468–489
Seeman E, Vellas B, Meunier P, Roux C, Adami S, Aquino J, Semler J, Graham J, Sorensen O (2005) Vertebral and nonvertebral antifracture efficacy of strontium ranelate in very elderly women with osteoporosis. Osteoporos Int 16(Suppl 3):OC21:S6
European Medicines Agency. Summary of Product Characteristics (SPC). Available online at http://www.emea.eu.int/humandocs/PDFs/EPAR/protelos/H-560-PI-en.pdf
Reginster JY, Meunier PJ (2003) Strontium ranelate phase 2 dose-ranging studies: PREVOS and STRATOS studies. Osteoporos Int 14(Suppl 3):S56–S65
Reginster JY, Deroisy R, Dougados M, Jupsin I, Colette J, Roux C (2002) Prevention of early postmenopausal bone loss by strontium ranelate: the randomized, two-year, double-masked, dose-ranging, placebo-controlled PREVOS trial. Osteoporos Int 13(12):925–931
Meunier PJ, Slosman DO, Delmas PD, Sebert JL, Brandi ML, Albanese C, Lorenc R, Pors-Nielsen S, De Vernejoul MC, Roces A, Reginster JY (2002) Strontium ranelate: dose-dependent effects in established postmenopausal vertebral osteoporosis—a 2-year randomized placebo controlled trial. J Clin Endocrinol Metab 87(5):2060–2066
Jonsson B (1998) Targeting high-risk populations. Osteoporos Int 8(Suppl 1):S13–S16
Jonsson B, Christiansen C, Johnell O, Hedbrandt J, Karlsson G (1996) Cost-effectiveness of fracture prevention in established osteoporosis. Scand J Rheumatol Suppl 103:30–38
Borgstrom F, Johnell O, Kanis JA, Oden A, Sykes D, Jonsson B (2004) Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden: an economic evaluation based on the MORE study. Pharmacoeconomics 22(17):1153–1165
Kanis JA, Borgstrom F, Johnell O, Oden A, Sykes D, Jonsson B (2005) Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study. Osteoporos Int 16(1):15–25
Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, de Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 11(8):669–674
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(5):417–427
Melton LJ 3rd, Crowson CS, O’Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int 9(1):29–37
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(2):120–127
de Laet CE, van Hout BA, Burger H, Hofman A, Pols HA (1997) Bone density and risk of hip fracture in men and women: cross sectional analysis. Br Med J 315(7102):221–225
Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Br Med J 312(7041):1254–1259
Kanis JA, Johnell O, de Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (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(4):721–739
Statistics Sweden. Sweden’s Statistical Databases (SSD). Available online at http://www.scb.se/eng/databaser/ssd.asp
Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11(7):556–561
Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353(9156):878–882
Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ 3rd (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137(9):1001–1005
Jalava T, Sarna S, Pylkkanen L, Mawer B, Kanis JA, Selby P, Davies M, Adams J, Francis RM, Robinson J, McCloskey E (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18(7):1254–1260
Kanis JA, Oden A, Johnell O, de Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15(2):108–112
Oden A, Dawson A, Dere W, Johnell O, Jonsson B, Kanis JA (1998) Lifetime risk of hip fractures is underestimated. Osteoporos Int 8(6):599–603
Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, de Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15(1):38–42
Poor G, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1995) Determinants of reduced survival following hip fractures in men. Clin Orthop Oct(319):260–265
Kanis J, Johnell O, Oden A, de Laet C, Jonsson B, Oglesby A (2002) Excess mortality after vertebral fracture. WHO Collaborating Centre for Metabolic Bone Diseases, Sheffield, UK
Parker MJ, Anand JK (1991) What is the true mortality of hip fractures? Public Health 105(6):443–446
Kanis JA, Oden A, Johnell O, de Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32(5):468–473
Läkemedelsförmånsnämndens allmänna råd (2003) Stockholm
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(1):13–17
Zethraeus N, Borgström F, Johnell O, Kanis J, Jönsson B (2002) Costs and quality of life associated with osteoporosis related fractures—results from a Swedish survey. Working Paper Series in Economics and Finance, no 512, Stockholm School of Economics, Stockholm, Sweden
Stockholms stads budgetavräkning 2003. Available online at http://www.stockholm.se/files/71600-71699/file_71645.pdf
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(1):66–72
Meltzer D (1997) Accounting for future costs in medical cost-effectiveness analysis. J Health Econ 16(1):33–64
Ekman M, Zethraeus N, Dahlstrom U, Hoglund C (2002) Cost-effectiveness of bisoprolol in chronic heart failure. Lakartidningen 99(7):646–650
FASS för förskrivare. Home page at http://www.fass.se
Priser för södra sjukvårdsregionen–Vårdtjänster per klinik (2003) Universitetssjukhuset i Lund
Burstrom K, Johannesson M, Diderichsen F (2001) Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 10(7):621–635
Kind P, Dolan P, Gudex C, Williams A (1998) Variations in population health status: results from a United Kingdom national questionnaire survey. Br Med J 316(7133):736–741
Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, de Laet C, Jonsson B (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15(1):20–26
Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15(7):1384–1392
Brazier JE, Green C, Kanis JA (2002) A systematic review of health state utility values for osteoporosis-related conditions. Osteoporos Int 13(10):768–776
Tidermark J, Zethraeus N, Svensson O, Tornkvist H, Ponzer S (2002) Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. J Orthop Trauma 16(1):34–38
(2002) Översyn av samhällsekonomiska metoder och kalkylvården på transportområdet—ASEK review of cost benefit calculation. Methods and valuations in the transport sector. SIKA Rapport 4
Persson U, Hjelmgren J (2003) Health services need knowledge of how the public values health. Lakartidningen 100(43):3436–3437
Borgstrom F, Johnell O, Kanis JA, Oden A, Sykes D, Jönsson B (2004) Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden—an economic evaluation based on the MORE study. Pharmacoeconomics 22(17):1153–1165
(2003) PROTELOS—prevention and treatment of postmenopausal osteoporosis. Clinical Investigators’ brochure no 7
Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD (1993) Predicting vertebral fracture incidence from prevalent fractures and bone density among non-black, osteoporotic women. Osteoporos Int 3(3):120–126
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Borgström, F., Jönsson, B., Ström, O. et al. An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting. Osteoporos Int 17, 1781–1793 (2006). https://doi.org/10.1007/s00198-006-0193-z
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DOI: https://doi.org/10.1007/s00198-006-0193-z