Mickael Hiligsmann1, Setareh A Williams2, Lorraine A Fitzpatrick2, Stuart S Silverman3, Richard Weiss2, Jean-Yves Reginster4. 1. Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht 6200 MD, the Netherlands. Electronic address: m.hiligsmann@maastrichtuniversity.nl. 2. Radius Health, Inc., Waltham, MA, United States. 3. Cedar-Sinai Medical Center and UCLA School of Medicine, Los Angeles, CA, United States. 4. Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.
Abstract
OBJECTIVES: There is emerging evidence supporting sequential therapy with an osteoanabolic followed by an 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 with teriparatide (TPTD) followed by ALN (TPTD/ALN). METHODS: A previously validated Markov microsimulation model was adapted to estimate the cost-effectiveness of sequential ABL/ALN compared with sequential TPTD/ALN and no treatment with a lifetime horizon from the US payer perspective. Patients were assumed to receive ABL or TPTD for 18 months followed by 5 years of ALN in line with clinical recommendations. The effects of ABL on fracture risk were derived from the ACTIVExtend trial. The effects of TPTD were assumed to be maintained during subsequent ALN treatment, consistent with ACTIVExtend findings for ABL. Evaluation was completed for patients, aged 50-80 years with a BMD T-score ≤ -3.5 or with a T-score between -2.5 and -3.5 and a history of ≥ one osteoporotic fracture. RESULTS: In all simulated populations, sequential ABL/ALN therapy was dominant (lower costs, higher QALYs) compared with sequential TPTD/ALN therapy, resulting from the improved efficacy and lower drug price of ABL. Probabilistic sensitivity analyses suggested that ABL/ALN was dominant in at least 99% of the simulations. Compared to no treatment, the cost per QALY gained of ABL/ALN was always below $130,000. CONCLUSIONS: Sequential ABL/ALN therapy is a cost-effective (dominant) strategy compared with sequential TPTD/ALN therapy for the treatment of US women at increased risk of fractures.
OBJECTIVES: There is emerging evidence supporting sequential therapy with an osteoanabolic followed by an 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 with teriparatide (TPTD) followed by ALN (TPTD/ALN). METHODS: A previously validated Markov microsimulation model was adapted to estimate the cost-effectiveness of sequential ABL/ALN compared with sequential TPTD/ALN and no treatment with a lifetime horizon from the US payer perspective. Patients were assumed to receive ABL or TPTD for 18 months followed by 5 years of ALN in line with clinical recommendations. The effects of ABL on fracture risk were derived from the ACTIVExtend trial. The effects of TPTD were assumed to be maintained during subsequent ALN treatment, consistent with ACTIVExtend findings for ABL. Evaluation was completed for patients, aged 50-80 years with a BMD T-score ≤ -3.5 or with a T-score between -2.5 and -3.5 and a history of ≥ one osteoporotic fracture. RESULTS: In all simulated populations, sequential ABL/ALN therapy was dominant (lower costs, higher QALYs) compared with sequential TPTD/ALN therapy, resulting from the improved efficacy and lower drug price of ABL. Probabilistic sensitivity analyses suggested that ABL/ALN was dominant in at least 99% of the simulations. Compared to no treatment, the cost per QALY gained of ABL/ALN was always below $130,000. CONCLUSIONS: Sequential ABL/ALN therapy is a cost-effective (dominant) strategy compared with sequential TPTD/ALN therapy for the treatment of US women at increased risk of fractures.
Authors: Nannan Li; Dennis Cornelissen; Stuart Silverman; Daniel Pinto; Lei Si; Ingrid Kremer; Sandrine Bours; Robin de Bot; Annelies Boonen; Silvia Evers; Joop van den Bergh; Jean-Yves Reginster; Mickaël Hiligsmann Journal: Pharmacoeconomics Date: 2020-10-07 Impact factor: 4.981
Authors: Elizabeth M Curtis; Jean-Yves Reginster; Nasser Al-Daghri; Emmanuel Biver; Maria Luisa Brandi; Etienne Cavalier; Peyman Hadji; Philippe Halbout; Nicholas C Harvey; Mickaël Hiligsmann; M Kassim Javaid; John A Kanis; Jean-Marc Kaufman; Olivier Lamy; Radmila Matijevic; Adolfo Diez Perez; Régis Pierre Radermecker; Mário Miguel Rosa; Thierry Thomas; Friederike Thomasius; Mila Vlaskovska; René Rizzoli; Cyrus Cooper Journal: Aging Clin Exp Res Date: 2022-03-24 Impact factor: 4.481