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Cost effectiveness of denosumab versus oral bisphosphonates for postmenopausal osteoporosis in the US.

https://arctichealth.org/en/permalink/ahliterature108612
Source
Appl Health Econ Health Policy. 2013 Oct;11(5):485-97
Publication Type
Article
Date
Oct-2013
Author
Anju Parthan
Morgan Kruse
Nicole Yurgin
Joice Huang
Hema N Viswanathan
Douglas Taylor
Author Affiliation
OptumInsight, Cambridge, MA, USA, anju.parthan@optum.com.
Source
Appl Health Econ Health Policy. 2013 Oct;11(5):485-97
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alendronate - economics - therapeutic use
Antibodies, Monoclonal, Humanized - economics - therapeutic use
Bone Density Conservation Agents - economics - therapeutic use
Cost-Benefit Analysis
Diphosphonates - economics - therapeutic use
Drug Costs
Etidronic Acid - analogs & derivatives - economics - therapeutic use
Female
Health Care Costs - statistics & numerical data
Humans
Insurance, Health, Reimbursement - economics - statistics & numerical data
Markov Chains
Osteoporosis, Postmenopausal - economics - prevention & control
Sweden
Thiophenes - economics - therapeutic use
United States
Abstract
In the US, 26 % of women aged =65 years, and over 50 % of women aged =85 years are affected with postmenopausal osteoporosis (PMO). Each year, the total direct health care costs are estimated to be $US12-18 billion.
The cost effectiveness of denosumab versus oral bisphosphonates in postmenopausal osteoporotic women from a US third-party payer perspective was evaluated.
A lifetime cohort Markov model was developed with seven health states: 'well', hip fracture, vertebral fracture, 'other' osteoporotic fracture, post-hip fracture, post-vertebral fracture, and dead. During each cycle, patients could have a fracture, remain healthy, remain in a post-fracture state or die. Relative fracture risk reductions, background fracture risks, mortality rates, treatment-specific persistence rate, utilities, and medical and drug costs were derived using published sources. Expected costs and quality-adjusted life years (QALYs) were estimated for generic alendronate, denosumab, branded risedronate, and branded ibandronate in the overall PMO population and high-risk subgroups: (a) =2 of the following risks: >70 years of age, bone mineral density (BMD) T score less than or equal to -3.0, and prevalent vertebral fracture; and (b) =75 years of age. Costs and QALYs were discounted at 3 % annually, and all costs were inflated to 2012 US dollars. Sensitivity analyses were conducted by varying parameters e.g., efficacies of interventions, costs, utilities, and the medication persistence ratio.
In the overall PMO population, total lifetime costs for alendronate, denosumab, risedronate, and ibandronate were $US64,400, $US67,400, $US67,600 and $US69,200, respectively. Total QALYs were 8.2804, 8.3155, 8.2735 and 8.2691, respectively. The incremental cost-effectiveness ratio (ICER) for denosumab versus generic alendronate was $US85,100/QALY. Risedronate and ibandronate were dominated by denosumab. In the high-risk subgroup (a), total costs for alendronate, denosumab, risedronate and ibandronate were $US70,400, $US70,800, $US74,000 and $US76,900, respectively. Total QALYs were 7.2006, 7.2497, 7.1969 and 7.1841, respectively. Denosumab had an ICER of $US7,900/QALY versus generic alendronate and dominated all other strategies. Denosumab dominated all strategies in women aged =75 years. Base-case results between denosumab and generic alendronate were most sensitive to the relative risk of hip fracture for both drugs and the cost of denosumab.
In each PMO population examined, denosumab represented good value for money compared with branded bisphosphonates. Furthermore, denosumab was either cost effective or dominant compared with generic alendronate in the high-risk subgroups.
PubMed ID
23868102 View in PubMed
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Utilization of diabetes medication and cost of testing supplies in Saskatchewan, 2001.

https://arctichealth.org/en/permalink/ahliterature166115
Source
BMC Health Serv Res. 2006;6:159
Publication Type
Article
Date
2006
Author
Jeffrey A Johnson
Sheri L Pohar
Kristina Secnik
Nicole Yurgin
Zeenat Hirji
Author Affiliation
Institute of Health Economics, Edmonton, Canada. jeff.johnson@ualberta.ca
Source
BMC Health Serv Res. 2006;6:159
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Algorithms
Diabetes Mellitus, Type 1 - diagnosis - drug therapy
Diabetes Mellitus, Type 2 - diagnosis - drug therapy
Drug Costs
Drug Monitoring - economics - instrumentation
Drug Therapy, Combination
Drug Utilization Review
Female
Health Care Costs
Humans
Hypoglycemic Agents - economics - therapeutic use
Insurance, Pharmaceutical Services - utilization
Male
Metformin - economics - therapeutic use
Middle Aged
Saskatchewan
Abstract
The purpose of this study was to describe the patterns of antidiabetic medication use and the cost of testing supplies in Canada using information collected by Saskatchewan's Drug Plan (DP) in 2001. The diabetes cohort (n = 41,630) included individuals who met the National Diabetes Surveillance System (NDSS) case definition. An algorithm was then used to identify subjects as having type 1 or type 2 diabetes. Among those identified as having type 2 diabetes (n = 37,625), 38% did not have records for antidiabetic medication in 2001. One-third of patients with type 2 diabetes received monotherapy. Metformin, alone or in combination with other medications, was the most commonly prescribed antidiabetic medication. Just over one-half of the all patients with diabetes had a DP records for diabetes testing supplies. For individuals (n = 4,005) with type 1 diabetes, 79% had a DP record for supplies, with an average annual cost of 472 +/- 560 dollars. For type 2 diabetes, 50% had records for testing supplies, with an average annual cost of 122 +/- 233 dollars. Those individuals with type 2 diabetes who used insulin had higher testing supply costs than those on oral antidiabetic medication alone (359 vs 131 dollars; p
Notes
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PubMed ID
17164006 View in PubMed
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