OBJECTIVES: To evaluate the cost-effectiveness of bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid), raloxifene, calcitonin and strontium ranelate, with a combination of calcium and Vitamin D as comparator, for the prevention of osteoporosis-related fractures in Thai post-menopausal women. METHODS: A Markov state transition model with 1-year cycle length was designed to simulate the cost-effectiveness of seven osteoporosis treatment interventions, compared with calcium and vitamin D, in Thai post-menopausal women aged 50-70 years. The model health states were categorized as osteopenia/no fracture, hip fracture, vertebral fracture, post-hip fracture, post-vertebral fracture and death. Treatment effects were obtained from published literature. The analysis was conducted using a societal perspective and included direct medical, direct nonmedical and indirect costs. Uncertainty was investigated by a probabilistic Monte Carlo simulation. Treatment outcomes were measured in terms of number of fractures avoided, number of life-years gained and quality-adjusted life-years (QALY) gained. Cost-effectiveness was defined as an ICER of less than 300,000 Baht (an incremental cost of < 300,000 Baht for an outcome of no fracture for 1 year). RESULTS: 1) For patients with no prior fracture (primary prevention), zoledronic acid is cost-effective at > 65 years, alendronate, risedronate and ibandronate at > 70 years. 2) For patients with prior vertebral fracture (secondary prevention), zoledronic acid is cost-effective at > 50 years, alendronate, risedronate and ibandronate at > 55 years, raloxifene and strontium ranelate at > 60 years; and 3) For patients with prior non-vertebral fractures, zoledronic acid is cost-effective at > 60 years, alendronate at > 65 years, and risedronate and ibandronate at > 70 years. CONCLUSIONS: Zoledronic acid, followed by other bisphosphonates, is the most costeffective treatment option for both primary and secondary fracture prevention in Thai postmenopausal women with osteoporosis. These findings should be implemented in the government policy for selecting appropriate anti-osteoporotic drugs and reimbursement support strategy for Thai postmenopausal women with osteoporosis.
Pongchaiyakul, C., Songpattanasilp, T., & Taechakraichana, N. (2010). PMS7 A COST-EFFECTIVENESS ANALYSIS OF OSTEOPOROSIS TREATMENT FOR FRACTURE PREVENTION IN POSTMENOPAUSAL THAI WOMEN: A COMPARISON OF SEVEN TREATMENT OPTIONS. Value in Health, 13(7), A558. https://doi.org/10.1016/s1098-3015(11)73342-3