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Cost Effectiveness of Denosumab for Secondary Prevention of Osteoporotic Fractures Among Postmenopausal Women in China: An Individual-Level Simulation Analysis

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Abstract

Objective

This study evaluated the cost effectiveness of denosumab versus alendronate for secondary prevention of osteoporotic fractures among post-menopausal women in China.

Methods

A validated individual-level simulation model of osteoporotic fractures in the Chinese setting was adapted. Allowing both treatment discontinuation and waning effects, the analysis aimed to evaluate the incremental cost-effectiveness ratio of denosumab compared to alendronate by simulating a cohort of previously fractured individuals over the residual lifetime from the healthcare system perspective. Hip, vertebral, and wrist/humeral fractures were tracked along with the associated medical costs and quality-adjusted life-years. Age-related health state utility values, health state utility values of fractures, costs, fracture incidence, and mortality risks for Chinese were used whenever available. Comparative effectiveness data were obtained from a published network meta-analysis. One-way and probabilistic sensitivity analyses were conducted.

Results

In the base case, denosumab was dominated by alendronate with incremental costs of CN¥2743 (US$425) and incremental health outcomes of − 0.20 quality-adjusted life-years at its current price in mainland China. It remained dominated in all one-way sensitivity analysis robustness checks. However, denosumab was cost effective if both drugs did not carry any waning effects. In the probabilistic sensitivity analysis, denosumab remained dominated in all replications.

Conclusions

Denosumab is not cost effective for preventing secondary fractures among overall postmenopausal women in China. It is advisable to identify alternative denosumab regimens for high-risk subgroups among previously fractured postmenopausal women.

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Author information

Author notes

  1. Yawen Jiang, Shan Jiang have contributed equally to the article.

Authors and Affiliations

  1. School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China

    Yawen Jiang, Limin Li, Si Shi & Mincai Li

  2. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Shan Jiang

  3. School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia

    Lei Si

  4. School of Health Policy & Management, Nanjing Medical University, Nanjing, Jiangsu, China

    Lei Si

  5. Locked Bag 1797, Penrith, NSW, 2751, Australia

    Lei Si

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Correspondence to Lei Si.

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Funding

This project was funded in part by the National Natural Science Foundation of China (Grant No. 72004242). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Conflicts of Interest/Competing Interests

The authors have no conflicts of interest that are directly relevant to the content of this article.

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Availability of Data and Material

The data analyzed during the study are presented in the article and its supplementary materials.

Code Availability

The model used in this study was provided to the journal’s peer reviewers for their reference when reviewing the manuscript and is available from the lead author and the corresponding author upon reasonable requests.

Authors’ Contributions

YJ and LS had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: YJ and LS. Acquisition of data: YJ, SJ, SS, ML, and LS. Drafting of the manuscript: YJ and SJ. Critical revision of the manuscript for important intellectual content: LL, SS, ML, and LS. Modeling: YJ and LLi. Analysis and interpretation: YJ and LL. Obtained funding: YJ. Administrative, technical, or material support: SJ, SS, and LS.

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Jiang, Y., Jiang, S., Li, L. et al. Cost Effectiveness of Denosumab for Secondary Prevention of Osteoporotic Fractures Among Postmenopausal Women in China: An Individual-Level Simulation Analysis. Appl Health Econ Health Policy 21, 489–499 (2023). https://doi.org/10.1007/s40258-022-00784-3

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