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Cost-effectiveness of alternative treatments for women with osteoporosis in Canada.

https://arctichealth.org/en/permalink/ahliterature168355
Source
Curr Med Res Opin. 2006 Jul;22(7):1425-36
Publication Type
Article
Date
Jul-2006
Author
Ron Goeree
Gord Blackhouse
Jonathan Adachi
Author Affiliation
Program for Assessment of Technology in Health (PATH), McMaster University, Ontario, Canada. goereer@mcmaster.ca
Source
Curr Med Res Opin. 2006 Jul;22(7):1425-36
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Aged
Alendronate - economics - therapeutic use
Bone Density Conservation Agents - economics - therapeutic use
Canada
Cost-Benefit Analysis
Decision Support Techniques
Etidronic Acid - analogs & derivatives - economics - therapeutic use
Female
Humans
Markov Chains
Osteoporosis, Postmenopausal - drug therapy - economics
Raloxifene - economics - therapeutic use
Abstract
During the years following menopause, estrogen levels decline leading to accelerated bone loss and an increased risk of osteoporosis and osteoporosis-related fractures.
Using a Markov model and decision analytic techniques, the long-term costs and outcomes of five treatment and secondary prevention strategies for osteoporosis were compared: 'no intervention', alendronate, etidronate, risedronate, and raloxifene. The base case analysis examined postmenopausal (65 year old) osteoporotic women without prior fracture. Probabilistic sensitivity analysis (PSA) was used to incorporate the impact of parameter uncertainty, and deterministic sensitivity analysis (DSA) was used to compare alternative patient populations and modeling assumptions. Life years and Quality Adjusted Life Years (QALYs) were used as measures of effectiveness.
In the base case analysis, risedronate was dominated by etidronate and alendronate. Alendronate and etidronate were projected to have similar costs and QALYs, and the efficiency frontier was represented by 'no intervention', etidronate, alendronate, and raloxifene (Can$32 571, Can$38 623 and Can$114 070 per QALY respectively). Alternative assumptions of raloxifene's impact on CHD and breast cancer, alternative discount rates and alternative patient risk factors (e.g., starting age of therapy, CHD risk, and prior fracture risk) had significant impacts on the overall cost-effectiveness results for both the bisphosphonates and raloxifene.
Using conventionally quoted benchmarks and compared to no therapy, alendronate, etidronate, and raloxifene would all be considered cost-effective alternatives for treating women with osteoporosis. Potential limitations of this study include the usual caveats and cautions associated with long-term projection models and the fact that not all inputs into the model are Canadian data sources.
PubMed ID
16834841 View in PubMed
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Greater first year effectiveness drives favorable cost-effectiveness of brand risedronate versus generic or brand alendronate: modeled Canadian analysis.

https://arctichealth.org/en/permalink/ahliterature160303
Source
Osteoporos Int. 2008 May;19(5):687-97
Publication Type
Article
Date
May-2008
Author
D T Grima
A. Papaioannou
M F Thompson
M K Pasquale
J D Adachi
Author Affiliation
Cornerstone Research Group Inc., Burlington, ON, L7L 5Y6, Canada. dgrima@cornerstone-research.com
Source
Osteoporos Int. 2008 May;19(5):687-97
Date
May-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alendronate - economics - therapeutic use
Bone Density - drug effects
Bone Density Conservation Agents - economics - therapeutic use
Canada
Cost-Benefit Analysis
Etidronic Acid - analogs & derivatives - economics - therapeutic use
Female
Hip Fractures - drug therapy - economics
Humans
Models, Biological
Osteoporosis, Postmenopausal - drug therapy - economics
Quality-Adjusted Life Years
Severity of Illness Index
Abstract
The RisedronatE and ALendronate (REAL) study provided a unique opportunity to conduct cost-effectiveness analyses based on effectiveness data from real-world clinical practice. Using a published osteoporosis model, the researchers found risedronate to be cost-effective compared to generic or brand alendronate for the treatment of Canadian postmenopausal osteoporosis in patients aged 65 years or older.
The REAL study provides robust data on the real-world performance of risedronate and alendronate. The study used these data to assess the cost-effectiveness of brand risedronate versus generic or brand alendronate for treatment of Canadian postmenopausal osteoporosis patients aged 65 years or older.
A previously published osteoporosis model was populated with Canadian cost and epidemiological data, and the estimated fracture risk was validated. Effectiveness data were derived from REAL and utility data from published sources. The incremental cost per quality-adjusted life-year (QALY) gained was estimated from a Canadian public payer perspective, and comprehensive sensitivity analyses were conducted.
The base case analysis found fewer fractures and more QALYs in the risedronate cohort, providing an incremental cost per QALY gained of $3,877 for risedronate compared to generic alendronate. The results were most sensitive to treatment duration and effectiveness.
The REAL study provided a unique opportunity to conduct cost-effectiveness analyses based on effectiveness data taken from real-world clinical practice. The analysis supports the cost-effectiveness of risedronate compared to generic or brand alendronate and the use of risedronate for the treatment of osteoporotic Canadian women aged 65 years or older with a BMD T-score
PubMed ID
18008100 View in PubMed
Less detail