Abstract
Cost-effectiveness analysis of FRAX (R) intervention thresholds (ITs) in Singaporean women > 50 years of age showed that generic alendronate was cost-effective at age-dependent major osteoporotic fracture (MOF) IT from the ages of 65 years for both full and real-world adherence whilst hip fracture (HF) ITs were cost-effective from the ages of 60 and 65 years. Alendronate was cost-effective irrespective of age only at fixed MOF IT of 14% and HF IT of 3.5%. Introduction FRAX (R)-based intervention thresholds (ITs) were recently identified for osteoporosis management in Singapore. This study aimed to assess the cost-effectiveness of ITs in Singaporean women over the age of 50 years. Methods A validated Markov microsimulation model was used to estimate the lifetime healthcare costs (SGD2019) per quality-adjusted life-years (QALY) of generic alendronate compared with no treatment. Cost-effectiveness of age-dependent FRAX (R) major osteoporotic fracture (MOF) and hip fracture (HF) ITs was explored. In addition, ITs that would lead to cost-effectiveness were computed. Fracture incidence and cost data were obtained from the Ministry of Health and a previously published Singaporean study. A cost-effectiveness threshold of SGD 62,500/QALY gained was used, based conservatively on 0.7 times the Singapore GDP per capita. Results Generic alendronate was shown to be cost-effective at MOF ITs from the ages of 65 years, while HF ITs were cost-effective from the ages of 60 and 65 years, assuming full and real-world adherence, respectively. A 14% MOF and a 3.5% HF ITs were required for alendronate to be cost-effective above 50 years. Conclusion This study suggests that the treatment of Singaporean women with alendronate is cost-effective at age-dependant FRAX (R) intervention thresholds at 65 years and older. Furthermore, identifying women at any age above 50 years with a 10-year risk of MOF or HF of 14% or 3.5% would lead to efficient use of resources. Cost-effective access to therapy for patients at high fracture probability based on FRAX (R) could contribute to reduce the growing burden of osteoporotic fractures in Singapore.
Original language | English |
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Pages (from-to) | 133-144 |
Number of pages | 12 |
Journal | Osteoporosis International |
Volume | 32 |
Issue number | 1 |
Early online date | 14 Aug 2020 |
DOIs | |
Publication status | Published - Jan 2021 |
Keywords
- Alendronate
- Cost-effectiveness analysis
- FRAX
- Intervention thresholds
- Osteoporosis
- Singapore
- QUALITY-OF-LIFE
- POSTMENOPAUSAL WOMEN
- MEDICATION ADHERENCE
- SUBSEQUENT FRACTURE
- ECONOMIC BURDEN
- HIP FRACTURE
- RISK
- MORTALITY
- MEN
- BISPHOSPHONATES