TY - JOUR
T1 - Cost-effectiveness of sequential treatment with abaloparatide vs. teriparatide for United States women at increased risk of fracture
AU - Hiligsmann, Mickael
AU - Williams, Setareh A.
AU - Fitzpatrick, Lorraine A.
AU - Silverman, Stuart S.
AU - Weiss, Richard
AU - Reginster, Jean-Yves
N1 - Funding Information:
The authors are grateful to the Prince Mutaib Chair for Biomarkers of Osteoporosis, King Saud University for its support, and to Interface Science et Recherche ASBL for medical writing support.
Funding Information:
This research was funded by Radius Health, Inc., Waltham MA.
Publisher Copyright:
© 2019 The Authors
PY - 2019/10
Y1 - 2019/10
N2 - 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 = 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. (C) 2019 The Authors. Published by Elsevier Inc.
AB - 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 = 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. (C) 2019 The Authors. Published by Elsevier Inc.
KW - Abaloparatide
KW - Economic evaluation
KW - Osteoporosis
KW - Teriparatide
KW - QUALITY-OF-LIFE
KW - BONE-MINERAL DENSITY
KW - POSTMENOPAUSAL WOMEN
KW - VERTEBRAL FRACTURES
KW - EXCESS MORTALITY
KW - HIP FRACTURE
KW - OSTEOPOROSIS TREATMENT
KW - ORAL BISPHOSPHONATES
KW - ECONOMIC-EVALUATION
KW - HEALTH
U2 - 10.1016/j.semarthrit.2019.01.006
DO - 10.1016/j.semarthrit.2019.01.006
M3 - Article
C2 - 30737062
SN - 0049-0172
VL - 49
SP - 184
EP - 196
JO - Seminars in Arthritis and Rheumatism
JF - Seminars in Arthritis and Rheumatism
IS - 2
ER -