Cost-effective analysis of anti-osteoporosis medications for primary prevention of fractures
| Autor: | Po-Ching Lo, 羅柏青 |
|---|---|
| Rok vydání: | 2016 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 104 Background: The Taiwan National Health Insurance (NHI) currently reimburses anti-osteoporosis medications (AOMs) only for the secondary prevention of fractures but not for the primary prevention of fractures in Taiwanese osteoporosis patients. This study aimed to examine the cost-effectiveness of expanding reimbursement of AOMs from the secondary to primary prevention of fractures in the perspective of Taiwan National Health Insurance Administration (NHIA), and to estimate the reduction of health loss due to the expansion of reimbursement of AOMs over the next 20 years. Method: This study applied a cost-utility analysis to estimate the incremental costs, quality-adjusted life-years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) of expanding reimbursement of AOMs from the secondary to primary prevention of factures. AOMs including alendronate, risedronate, zoledronate, and denosumab were evaluated. A Markov model was developed to simulate long-term costs and health outcomes in both male and female osteoporosis patients in Taiwan. The model focused on only direct medical costs. The AOM’s clinical efficacy, mortality rate, and health utility were retrieved from literature review. The baseline fracture risks and osteoporosis and fractures related medical costs among Taiwanese osteoporosis patients were obtained by analyzing Taiwan’s National Health Insurance Research Database. The discount rate of 3% was used for both costs and health outcomes. The robustness of the ICER estimates was assessed in several sensitivity analyses. Results: The result indicated that reimbursing zoledronate in female patients, and reimbursing alendronate, zoledronate and denosumab in male patients for the primary prevention of fracture was highly likely cost-effective. The ICER of reimbursing zoledronate for the primary prevention of fractures in female patients was TWD 1545940 per QALY gained; the ICER of reimbursing alendronate, zoledronate and denosumab in male patients, TWD 1151401, TWD 891126, and TWD 1014925 per QALY gained, respectively. The reduction of health loss due to expanding AOMs reimbursement over the next 20 years will increase along with aging population in Taiwan. Using alendronate as an example, reimbursing alendronate for the primary prevention of fracture will decrease 9346 Life-Years (LYs) loss (95% confidence interval (CI), 9127, 9565) and 44843 QALYs loss (95% CI, 43939, 45746) in female patients, and decrease 27086 LYs loss (95% CI, 26452, 27719) and 40571 QALYs loss (95% CI, 39709-41433) in male patients. Conclusion: Expanding reimbursement of AOMs for the primary prevention of fractures will reduce the disease burden in Taiwanese osteoporosis patients. Taiwan NHIA shall consider expanding the reimbursement of AOMs from the secondary to primary prevention of factures based on the cost-effectiveness analysis. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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