Cost-Effectiveness of Zoledronic Acid Versus Oral Alendronate for Postmenopausal Osteoporotic Women in China
Cost-Effectiveness of Zoledronic Acid Versus Oral Alendronate for Postmenopausal Osteoporotic Women in China
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DOI：
10.3389/fphar.2020.00456
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发表时间：
2020-04
影响因子：
5.6
通讯作者：
R. You;Yu Zhang;D. Wu;Jinyu Liu;Xinyu Qian;N. Luo;Takahiro Mori
中科院分区：
文献类型：
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作者：
R. You;Yu Zhang;D. Wu;Jinyu Liu;Xinyu Qian;N. Luo;Takahiro Mori
目的评价唑来膦酸治疗绝经后骨质疏松症的成本-效果。方法从医疗保健支付者的角度，采用马尔可夫微观模拟模型，比较唑来膦酸与阿仑膦酸钠在中国绝经后无骨折史的骨质疏松症妇女不同治疗开始年龄的成本-效果。结果唑来膦酸与阿仑膦酸钠的增量成本效果比（ICER）分别为65岁时23，581美元/QALY，70岁时17，367美元/QALY，75岁时14，714美元/QALY，80岁时12，169美元/QALY。在确定性敏感性分析中，研究表明，两个最具影响力的参数是唑来膦酸的年成本和唑来膦酸的髋部骨折相对风险。在概率敏感性分析中，唑来膦酸与阿仑膦酸盐相比具有成本效益的概率为70-100%，愿意支付29，340美元/QALY。结论在中国绝经后骨质疏松妇女中，从医疗保健支付者的角度来看，唑来膦酸治疗与每周口服阿仑膦酸盐相比，在所有年龄段都是成本效益好的。此外，阿仑膦酸钠治疗被证明是占主导地位的患者在65岁和70岁的完全持久性。这项研究将有助于临床医生和政策制定者更好地决定骨质疏松症治疗在中国的相对经济价值。
Objective This study aims to estimate the cost-effectiveness of yearly intravenous zoledronic acid treatment versus weekly oral alendronate for postmenopausal osteoporotic women in China. Methods We used a Markov microsimulation model to compare the cost-effectiveness of zoledronic acid with alendronate in Chinese postmenopausal osteoporotic women with no fracture history at various ages of therapy initiation from health care payer perspective. Results The incremental cost-effectiveness ratios (ICERs) for the zoledronic acid versus alendronate were $23,581/QALY at age 65 years, $17,367/QALY at age 70 years, $14,714/QALY at age 75 years, and $12,169/QALY at age 80 years, respectively. In deterministic sensitivity analyses, the study demonstrated that the two most impactful parameters were the annual cost of zoledronic acid and the relative risk of hip fracture with zoledronic acid. In probabilistic sensitivity analyses, the probabilities of zoledronic acid being cost-effective compared with alendronate were 70–100% at a willingness-to-pay of $29,340 per QALY. Conclusions Among postmenopausal osteoporotic women in China, zoledronic acid therapy is cost-effective at all ages examined from health care payer perspective, compared with weekly oral alendronate. In addition, alendronate treatment is shown to be dominant for patients at ages 65 and 70 with full persistence. This study will help clinicians and policymakers make better decisions about the relative economic value of osteoporosis treatments in China.