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A Systematic Review of Cost-Effectiveness Analyses of Drugs for Postmenopausal Osteoporosis

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Abstract

Background

Given the limited availability of healthcare resources and the recent introduction of new anti-osteoporosis drugs, the interest in the cost effectiveness of drugs in postmenopausal osteoporosis remains and even increases.

Objective

This study aims to identify all recent economic evaluations on drugs for postmenopausal osteoporosis, to critically appraise the reporting quality, and to summarize the results.

Methods

A literature search using Medline, the National Health Service Economic Evaluation database and the Cost-Effectiveness Analysis Registry was undertaken to identify original articles published between January 1, 2008 and December 31, 2013. Studies that assessed cost effectiveness of drugs in postmenopausal osteoporosis were included. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to assess the quality of reporting of these articles.

Results

Of 1,794 articles identified, 39 studies fulfilled the inclusion criteria. They were conducted in 14 different countries and nine active interventions were assessed. When compared with no treatment, active osteoporotic drugs were generally cost effective in postmenopausal women aged over 60–65 years with low bone mass, especially those with prior vertebral fractures. Key drivers of cost effectiveness included individual fracture risk, medication adherence, selected comparators and country-specific analyses. Quality of reporting varied between studies with an average score of 17.9 out of 24 (range 7–21.5).

Conclusion

This review found a substantial number of published cost-effectiveness analyses of drugs in osteoporosis in the last 6 years. Results and critical appraisal of these articles can help decision makers when prioritizing health interventions and can inform the development of future economic evaluations.

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Acknowledgments

No funding has been received for the conduct of this study and/or preparation of this manuscript.

Conflicts of interest

Mickael Hilisgmann has received research grant and/or consulting fees from Amgen, Pfizer, Novartis, Servier and SMB. John Kanis has received consulting fees, advisory board fees, lecture fees, and/or grant support from the majority of companies concerned with skeletal metabolism. Jean-Yves Reginster has received consulting fees, paid advisory boards, lecture fees, and/or grant support from Servier, Novartis, Negma, Lilly, Wyeth, Amgen, GlaxoSmithKline, Roche, Merckle, Nycomed, NPS, Theramex, UCB, Merck Sharp and Dohme, Rottapharm, IBSA, Genevrier, Teijin, Teva, Ebewee Pharma, Zodiac, Analis, Novo- Nordisk, and Bristol Myers Squibb. Stuart Silverman has served as an advisor for Amgen, Lilly, Novartis and Pfizer/Wyeth; has served as a consultant for Amgen, Genentech, Lilly, Novartis and Pfizer/Wyeth; and has received research support from Lilly and Pfizer/Wyeth. Annelies Boonen has received educational grants to my department from Merck, Abbot, Amgen and Pfizer as well as speaker honoraria from UCB and Pfizer. Caroline Wyers, Bram Ramaekers, Wafa Ben Sedrine and Silvia Evers have no conflicts of interest relevant to the content of this study.

Authors’ contributions

MH: study rationale and design, literature search, literature selection, quality assessment of studies, interpretation and reflection, writing of the manuscript, guarantor of the study. SE: quality assessment of studies, interpretation and reflection, reviewing of the manuscript. WBS: literature search, literature selection, reviewing of the manuscript. JK: interpretation and reflection, reviewing of the manuscript. BR: quality assessment of studies, reviewing of the manuscript. JYR: interpretation and reflection, reviewing of the manuscript. SS: literature selection, quality assessment of studies, reviewing of the manuscript. CW: literature selection, quality assessment of studies, reviewing of the manuscript. AB: study rationale and design, quality assessment of studies, interpretation and reflection, reviewing of the manuscript.

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Authors and Affiliations

  1. Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

    Mickaël Hiligsmann & Silvia M. Evers

  2. Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium

    Wafa Ben Sedrine & Jean-Yves Reginster

  3. Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK

    John A. Kanis

  4. Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands

    Bram Ramaekers

  5. Cedars-Sinai Medical Center, UCLA School of Medicine and the OMC Clinical Research Center, Beverly Hills, CA, USA

    Stuart Silverman

  6. Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands

    Caroline E. Wyers

  7. Department of Internal Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands

    Caroline E. Wyers

  8. Department of Internal Medicine, CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands

    Annelies Boonen

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  1. Mickaël Hiligsmann
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Correspondence to Mickaël Hiligsmann.

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Hiligsmann, M., Evers, S.M., Ben Sedrine, W. et al. A Systematic Review of Cost-Effectiveness Analyses of Drugs for Postmenopausal Osteoporosis. PharmacoEconomics 33, 205–224 (2015). https://doi.org/10.1007/s40273-014-0231-1

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