Cost-utility analysis of drugs for secondary bone fracture prevention among post-menopausal osteoporotic patients in Thailand
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Abstract
This study assessed the cost utility of medications used to prevent recurrent bone fractures among post-menopausal osteoporotic Thai women with a history of fractures. Economic evaluation was conducted using the Markov model-based cost-utility analysis approach under the societal perspective. Women age 50 and over with bone mass density T-score of less than or equal to 2.5 standard deviations and a history of fractures were included in the model, with a 1-year cycle length, until deceased. The model compared the expected costs and outcomes of calcium plus vitamin D alone (standard regimen) with those of calcium plus vitamin D with adjunct bisphosphonates (alendronate or risedronate), raloxifene, strontium, denosumab, or teriparatide. Bisphosphonates provided added health benefits whereas the other drugs did not. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained were approximately 92,995 Baht (US$2,997) for bisphosphonates and 1,701,932 Baht (US$54,848) for denosumab. Teriparatide was the most expensive with an ICER of 10,354,673 Baht (US$333,699) per QALY gained. The cost of drugs was the major expense. In conclusion, bisphosphonates are the most cost-effective adjunct interventions for post-menopausal osteoporotic women with a history of fractures treated under the Thai healthcare system.
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References
Adomaityte, J., Farooq, M., and Qayyum, R. (2008). Effect of raloxifene therapy on venous thromboembolism in postmenopausal women: a meta-analysis. Thrombosis and Haemostasis, 99(2), 338-342.
Black, D. M., Schwartz, A. V., Ensrud, K. E., Cauley, J. A., Levis, S., Quandt, S. A., Satterfield, S., Wallace, R. B., Bauer, D. C., Palermo, L., Wehren, L. E., Lombardi, A., Santora, A. C., and Cummings, S. R. (2006). Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. Jama, 296(24), 2927-2938.
Chaiyasong, S., Rattanachotphanit, T., Waleekhachonloet, O., and Sitthithanyakit, B. (2013). Cost-effectiveness of alendronate and risedronate for primary prevention of fractures in postmenopausal women. Isan Journal of Pharmaceutical Sciences, 9(2), 23-36.
Chariyalertsak, S., Suriyawongpisal, P., and Thakkinstain, A. (2001). Mortality after hip fractures in Thailand. International Orthopaedics, 25(5), 294-297.
Cummings, S. R., and Melton, L. J. (2002). Epidemiology and outcomes of osteoporotic fractures. The Lancet, 359(9319), 1761-1767.
Dell, R. M., Adams, A. L., Greene, D. F., Funahashi, T. T., Silverman, S. L., Eisemon, E. O., Zhou, H., Burchette, R. J., and Ott, S. M. (2012). Incidence of atypical nontraumatic diaphyseal fractures of the femur. Journal of Bone and Mineral Research, 27(12), 2544-2550.
Drug and Medical Supply Information Center (DMSIC). (2001). Prices of drugs and medical devices. [Online URL: http://dmsic.moph.go.th/dmsic/index.php?p=1&type=3&s=3&id=drug_normal] accessed on September 10, 2015.
Ekstrӧm, W., Németh, G., Samegård, E., Dalen, N., and Tidermark, J. (2009). Quality of life after a subtrochanteric fracture: a prospective cohort study on 87 elderly patients. Injury, 40(4), 371-376.
European Medicines Agency. (2013). Assessment report-periodic safety update report. [Online URL: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Assessment_Report_-_Variation/human/000560/WC500147168.pdf] accessed on September 10, 2015.
Fellow, J. L., Rindal, D. B., Barasch, A., Gullion, C. M., Rush, W., Pihlstrom, D. J., and Richman, J. (2011). ONJ in two dental practice-based research network regions. Journal of Dental Research, 90(4), 433-438.
Fraser, L. A., Vogt, K. N., Adachi, J. D., and Thabane, L. (2011). Fracture risk associated with continuation versus discontinuation of bisphosphonates after 5 years of therapy in patients with primary osteoporosis: a systematic review and meta-analysis. Therapeutics and Clinical Risk Management, 7, 157-166.
Hagino, H., Yamamoto, K., Ohshiro, H., Nakamura, T., Kishimoto, H., and Nose, T. (1999). Changing incidence of hip, distal radius, and proximal humerus fractures in Tottori Prefecture, Japan. Bone, 24(3), 265-270.
Hiligsmann, M., Ethgen, O., Richy, F., and Reginster, J. Y. (2008). Utility values associated with osteoporotic fracture: a systematic review of the literature. Calcified Tissue International, 82(4), 288-292.
Hiligsmann, M., Sedrine, W. B., and Reginster, J. Y. (2013). Cost-effectiveness of bazedoxifene compared with raloxifene in the treatment of postmenopausal osteoporotic women. Bone and mineral research, 28(4), 807-815.
Hiligsmann, M., Reginster, J. Y., Tosteson, A. N. A., Bukata, S. V., Saag, K. G., Gold, D. T., Halbout, P., Jiwa, F., Lewiecki, E. M., Pinto, D., Adachi, J. D., Al-Daghri, N., Bruyère, O., Chandran, M., Cooper, C., Harvey, N. C., Einhorn, T. A., Kanis, J. A., Kendler, D. L., Messina, O. D., Rizzoli, R., Si, L., and Silverman, S. (2019). Recommendations for the conduct of economic evaluations in osteoporosis: outcomes of an experts' consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the US branch of the International Osteoporosis Foundation. Osteoporosis International, 30(1), 45-57.
Jitapunkul, S., Thamarpirat, J., Chaiwanichsiri, D., and Boonhong, J. (2008). Incidence of vertebral fractures in Thai women and men: a prospective population-based study. Geriatrics & Gerontology International, 8(4), 251-258.
Kanis, J. A., Odén, A., McCloskey, E. V., Johansson, H., Wahl, D. A., Cooper, C., and IOF Working Group on Epidemiology and Quality of Life. (2012). A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis International, 23(9), 2239-2256.
Kanis, J. A., Adams, J., Borgström, F., Cooper, C., Jönsson, B., Preedy, D., Selby, P., and Compston, J. (2008). The cost-effectiveness of alendronate in the management of osteoporosis. Bone, 42(1), 4-15.
Kanis, J. A., Johnell, O., De Laet, C., Johansson, H., Oden, A., Delmas, P., Eisman, J., Fujiwara, S., Garnero, P., Kroger, H., McCloskey, E. V., Mellstrom, D., Melton, L. J., Pols, H., Reeve, J., Silman, A., and Tenenhouse, A. (2004). A meta-analysis of previous fracture and subsequent fracture risk. Bone, 35(2), 375-382.
Kim, K., Svedbom, A., Luo, X., Sutradhar, S., and Kannis, J. A. (2014). Comparative cost-effectiveness of bazedoxifene and raloxifene in the treatment of postmenopausal osteoporosis in Europe, using the FRAX algorithm. Osteoporosis International, 25(1), 325-337.
Kimman, M., Vathesatogkit, P., Woodward, M., Tai, E. S., Thumboo, J., Yamwong, S., Ratanachaiwong, W., Wee, H. L., and Sritara, P. (2013). Validity of the Thai EQ-5D in an occupational population in Thailand. Quality of Life Research, 22(6), 1499-1506.
Kingkeaw, P., Maleewong, U., Ngarmukos, C., and Teerawattananon, Y. (2013). Economic evaluation of screening and treatment options for postmenopausal osteoporosis. Nonthaburi: Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health.
Lau, E. M. C., Lee, J. K., Suriwongpaisal, P., Saw, S. M., Das De, S., Khir, A., and Sambrook, P. (2001). The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporosis International, 12(3), 239-243.
Lawrence, T. M., Wenn, R., Boulton, C. T., and Moran, C. G. (2010). Age-specific incidence of first and second fractures of the hip. The Journal of Bone and Joint Surgery, 92(2), 258-261.
Lee, Y. K., Jang, S., Jang, S., Lee, H. J., Park, C., Ha, Y. C., and Kim, D. Y. (2012). Mortality after vertebral fracture in Korea: analysis of the National Claim Registry. Osteoporosis International, 23(7), 1859-1865.
Looker, A. C., Orwoll, E. S., Johnston, C. C., Lindsay, R. L., Wahner, H. W., Dunn, W. L., Calvo, M.S., Harris, T. B., and Heyse, S. P. (1997). Prevalence of low femoral bone density in older U.S. adults from NHANES III. Journal of Bone and Mineral Research, 12(11), 1761-1768.
McClung, M. R., Boonen, S., Törring, O., Roux, C., Rizzoli, R., Bone, H. G., Benhamou, C. L., Lems, W. F., Minisola, S., Halse, J., Hoeck, H. C., Eastell, R., Wang, A., Siddhanti, S., and Cummings, S. R. (2012). Effect of denosumab treatment on the risk of fractures in subgroups of women with postmenopausal osteoporosis. Journal of Bone and Mineral Research, 27(1), 211-218.
Miksad, R. A., Lai, K. C., Dodson, T. B., Woo, S. B., Treister, N. S., Akinyemi, O., Bihrle, M., Maytal, G., August, M., Gazelle, G. S., and Swan, J. S. (2011). Quality of life implications of bisphosphonate-associated osteonecrosis of the jaw. The Oncologist, 16(1), 121-132.
Murphy, P. Z., Iranikhah, M., Deas, C. M., and Freeman, M. K. (2018). Fracture risk following discontinuation of teriparatide: a review of the literature. The Consultant Pharmacist, 33(7), 365-375.
National Institute for Health and Care Excellence. (2014). Osteoporotic overview. [Online URL:http://pathway.nice.org.uk/pathways/osteoporosis] accessed on September 10, 2015.
Papapoulos, S., Lippuner, K., Roux, C., Lin, C. J. F., Kendler, D. L., Lewiecki, E. M., Brandi, M. L., Czerwiński, E., Franek, E., Lakatos, P., Mautalen, C., Minisola, S., Reginster, J. Y., Jensen, S., Daizadeh, N. S., Wang, A., Gavin, M., Libanati, C., Wagman, R. B., and Bone, H. G. (2015). The effect of 8 or 5 years of denosumab treatment in postmenopausal women with osteoporosis: results from the FREEDOM extension study. Osteoporosis International, 26, 2773-2783.
Peasgood, T., Herrmann, K., Kanis, J. A., and Brazier, J. E. (2009). An updated systematic review of health state utility values for osteoporosis related conditions. Osteoporosis International, 20(6), 853-868.
Pongchaiyakul, C., Rojroongwasinkul, N., Chotmongkol, R., Kosulwat, V., Charoenkiatkul, S., and Rajatanavin, R. (2002). Bone mineral density in rural Thai adults living in Khon Kaen province. The Journal of Medical Association of Thailand, 85(2), 235-244.
Ström, O., Borgström, F., Kleman, M., McCloskey, E., Oden, A., Johansson, H., and Kanis, J. A. (2010). FRAX® and its applications in health economics-cost-effectiveness and intervention thresholds using bazedoxifene in a Swedish setting as an example. Bone, 47(2), 430-437.
Teerawattananon, Y., and Chaikledkaew, U. (2008). Thai health technology assessment guideline development. The Journal of Medical Association of Thailand, 91 Suppl 2, S11-15.
Thai Osteoporosis Foundation. (2000). Thai guideline of osteoporosis.
Thavorncharoensap, M., Leelahavarong, M., Doungthipsirkul, S., Sompitak, S., and Teerawattananon, Y. (2013). Assessing a societal value for a ceiling threshold in Thailand. Nonthaburi: Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health.
Tomasevic-Todorovic, S., Vazic, A., Issaka, A., and Hanna, F. (2018). Comparative assessment of fracture risk among osteoporosis and osteopenia patients: a cross-sectional study. Open Access Rheumatology: Research and Reviews, 10, 61-66.
Vaseenon, T., Luevitoonvechkij, S., Wongtriratanachai, P., and Rojanasthien, S. (2010). Long-term mortality after osteoporotic hip fracture in Chiang Mai, Thailand. Journal of Clinical Densitometry, 13(1), 63-67.
Woratanarat, P., Wajanavisit, W., Lertbusayanukul, C., Loahacharoensombat, W., and Ongphiphatanakul, B. (2005). Cost analysis of osteoporotic hip fractures. The Journal of Medical Association of Thailand, 88 Suppl 5, S96-104.
World Health Organization. (2010). International Statistical Classification of Diseases and Related Health Problems. 2, [Online URL:https://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf] accessed on September 10, 2015.
World Health Organization. (2015). Chronic diseases and health promotion. Retrieved 6 Aug 2015, [Online URL:http://www.who.int/chp/topics/rheumatic/en/] accessed on August 15, 2015.