Intervention thresholds for denosumab in the UK using a FRAX®-based cost-effectiveness analysis
Journal article
Ström, O., Jönsson, Bengt and Kanis, John A.. (2013). Intervention thresholds for denosumab in the UK using a FRAX®-based cost-effectiveness analysis. Osteoporosis International. 24(4), pp. 1491 - 1502. https://doi.org/10.1007/s00198-012-2115-6
Authors | Ström, O., Jönsson, Bengt and Kanis, John A. |
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Abstract | Summary: The objective was to undertake a health economic analysis of denosumab for the treatment of osteoporosis in women from the UK, using the FRAX® tool. Denosumab was cost-effective in women with a risk of major osteoporotic fracture meeting or exceeding approximately 20 % who are unable to take, comply with or tolerate generic alendronate. Introduction: Denosumab is a novel biologic agent developed for the treatment of osteoporosis, which has been shown to reduce the risk of fractures in a phase-III trial. The objective of the present study was to undertake a health economic analysis of denosumab in women from the UK. Ten-year probabilities of a major osteoporotic fracture at which denosumab is a cost-effective alternative to no treatment, generic alendronate, risedronate and strontium ranelate were estimated. Methods: A previously published Markov model was adapted to incorporate fracture and mortality risk assessments based on absolute fracture probability, as estimated by FRAX®. The model included treatment persistence and residual effect after discontinuation. Results: At a willingness-to-pay ( WTP ) of £30,000 per quality-adjusted life year and a 10-year fracture probability equivalent to a woman with a prior fragility fracture, denosumab was cost-effective compared to no treatment from the age of 70 years. At the same WTP, denosumab was—irrespective of age—cost-effective compared to no treatment at a major osteoporotic fracture probability of approximately 20 %. Denosumab was estimated to cost-effectively replace strontium, risedronate and generic alendronate at 10-year probabilities exceeding 11, 19 and 32 %, respectively. Conclusion: FRAX® facilitates the estimation of cost-effectiveness-based intervention thresholds applicable to patients with different combinations of clinical risk factors, which more closely matches the situation in clinical practice. Denosumab is cost-effective in patients with major osteoporotic fracture probabilities meeting or exceeding approximately 20 % who are unable to take, comply with or tolerate generic alendronate. |
Keywords | cost-effectiveness; denosumab; fracture; FRAX; osteoporosis |
Year | 2013 |
Journal | Osteoporosis International |
Journal citation | 24 (4), pp. 1491 - 1502 |
Publisher | Springer-Verlag |
ISSN | 0937-941X |
Digital Object Identifier (DOI) | https://doi.org/10.1007/s00198-012-2115-6 |
Scopus EID | 2-s2.0-84876473359 |
Page range | 1491 - 1502 |
Research Group | Institute for Health and Ageing |
Publisher's version | File Access Level Controlled |
Place of publication | United Kingdom |
https://acuresearchbank.acu.edu.au/item/87779/intervention-thresholds-for-denosumab-in-the-uk-using-a-frax-based-cost-effectiveness-analysis
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