Cost-effectiveness of sequential treatment with abaloparatide followed by alendronate vs. alendronate monotherapy in women at increased risk of fracture: A US payer perspective.

Autor: Hiligsmann M; Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands. Electronic address: m.hiligsmann@maastrichtuniversity.nl., Williams SA; Radius Health, Inc., Waltham, MA, United States., Fitzpatrick LA; Radius Health, Inc., Waltham, MA, United States., Silverman SS; Cedar-Sinai Medical Center and UCLA School of Medicine, Los Angeles, CA, United States., Weiss R; Radius Health, Inc., Waltham, MA, United States., Reginster JY; Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, KSA, Saudi Arabia.
Jazyk: angličtina
Zdroj: Seminars in arthritis and rheumatism [Semin Arthritis Rheum] 2020 Jun; Vol. 50 (3), pp. 394-400. Date of Electronic Publication: 2020 Feb 13.
DOI: 10.1016/j.semarthrit.2020.02.004
Abstrakt: Objectives: Emerging evidence supports sequential therapy with anabolic followed by antiresorptive in patients at high-risk of fragility fractures. This study assessed the cost-effectiveness of sequential treatment with abaloparatide (ABL) followed by alendronate (ALN) [(ABL/ALN)] compared to ALN monotherapy and to sequential treatment starting with antiresorptive therapy (ALN/ABL/ALN).
Methods: A previously validated Markov microsimulation model was used to estimate the cost-effectiveness of sequential ABL/ALN compared to ALN monotherapy and to sequential ALN/ABL/ALN from a lifetime US payer perspective. In line with practice guidelines, patients were assumed to receive ABL for 18 months followed by 5 years of ALN, or ALN monotherapy for 5 years, or a sequence of ALN for 2 years followed by 18 months of ABL and then by 3 years ALN. Evaluation was conducted for patients aged 50-80 years old with a BMD T-score ≤-3.5 and without a history of prior fracture, or with a T-score between -2.5 and -3.5 and a history of ≥ 1 osteoporotic fracture.
Results: Sequential ABL/ALN was cost-effective (threshold of US$150,000 per QALY) vs generic ALN monotherapy in women ≥60 years with a BMD T-score ≤-3.5 and in women with BMD T-score between -2.5 and -3.5 and history of osteoporotic fracture. In all simulated populations, sequential ABL/ALN therapy was dominant (lower costs, more QALYs) compared with sequential ALN/ABL/ALN, resulting from limited effect of ABL in patients previously treated with an antiresorptive agent.
Conclusions: Sequential ABL/ALN therapy is cost-effective vs ALN monotherapy for US postmenopausal women aged ≥60 years at increased risk of fractures.
Competing Interests: Declaration of Competing Interest Mickael Hiligsmann has received research grant through institution from Amgen, Bayer, Radius Health, Inc., and Teva/Theramex; lecture fees from Radius Health, Inc. Setareh Williams and Richard Weiss are employees and shareholder of Radius Health, Inc. Lorie Fitzpatrick was an employee of Radius Health, Inc at the time of manuscript development but is currently a consultant to and shareholder of Radius Health, Inc. Stuart Silverman has received grant support from Amgen, Radius Health, Inc., and Lilly; consulting fees from Amgen and Radius Health; has served on scientific advisory boards for Lilly and Amgen; and has served on speakers bureaus for Amgen, Lilly and Radius Health, Inc. Jean-Yves Reginster has received consulting fees or paid advisory boards from IBSA-Genevrier, Mylan, Radius Health, Pierre Fabre, Teva; lecture fees when speaking at the invitation of sponsor: IBSA-Genevrier, Mylan, CNIEL, Dairy Research Council, Teva; grant support from industry (all through institution) from IBSA-Genevrier, Mylan, CNIEL, Radius Health, Inc.
(Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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