The cost effectiveness of teriparatide as a first-line treatment for glucocorticoid-induced and postmenopausal osteoporosis patients in SwedenReport as inadecuate




The cost effectiveness of teriparatide as a first-line treatment for glucocorticoid-induced and postmenopausal osteoporosis patients in Sweden - Download this document for free, or read online. Document in PDF available to download.

BMC Musculoskeletal Disorders

, 13:213

First Online: 30 October 2012Received: 24 February 2012Accepted: 09 October 2012

Abstract

BackgroundThis paper presents the model and results to evaluate the use of teriparatide as a first-line treatment of severe postmenopausal osteoporosis PMO and Glucocorticoid-induced osteoporosis GIOP. The study’s objective was to determine if teriparatide is cost effective against oral bisphosphonates for two large and high risk cohorts.

MethodsA computer simulation model was created to model treatment, osteoporosis related fractures, and the remaining life of PMO and GIOP patients. Natural mortality and additional mortality from osteoporosis related fractures were included in the model. Costs for treatment with both teriparatide and oral bisphosphonates were included. Drug efficacy was modeled as a reduction to the relative fracture risk for subsequent osteoporosis related fractures. Patient health utilities associated with age, gender, and osteoporosis related fractures were included in the model. Patient costs and utilities were summarized and incremental cost-effectiveness ratios ICERs for teriparatide versus oral bisphosphonates and teriparatide versus no treatment were estimated.

For each of the PMO and GIOP populations, two cohorts differentiated by fracture history were simulated. The first contained patients with both a historical vertebral fracture and an incident vertebral fracture. The second contained patients with only an incident vertebral fracture. The PMO cohorts simulated had an initial Bone Mineral Density BMD T-Score of −3.0. The GIOP cohorts simulated had an initial BMD T-Score of −2.5.

ResultsThe ICERs for teriparatide versus bisphosphonate use for the one and two fracture PMO cohorts were €36,995 per QALY and €19,371 per QALY. The ICERs for teriparatide versus bisphosphonate use for the one and two fracture GIOP cohorts were €20,826 per QALY and €15,155 per QALY, respectively.

ConclusionsThe selection of teriparatide versus oral bisphosphonates as a first-line treatment for the high risk PMO and GIOP cohorts evaluated is justified at a cost per QALY threshold of €50,000.

KeywordsGlucocorticoid-induced osteoporosis Postmenopausal osteoporosis Cost-effectiveness Fractures Teriparatide Bisphosphonate AbbreviationsBMDBone mineral density

CTComputed tomography

DXADual energy X-ray absorptiometry

Fxfracture

GIOPGlucocorticoid-induced osteoporosis

GPGeneral practitioner

ICERIncremental cost-effectiveness ratios

PMOPostmenopausal osteoporosis

PSAProbabilistic sensitivity analysis

QALYQuality adjusted life year

RxTreatment

SDStandard deviation

SEKSwedish Krona.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-13-213 contains supplementary material, which is available to authorized users.

Daniel R Murphy, Lee J Smolen, Timothy M Klein and Robert W Klein contributed equally to this work.

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Author: Daniel R Murphy - Lee J Smolen - Timothy M Klein - Robert W Klein

Source: https://link.springer.com/







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