Summary

This study evaluated the cost-effectiveness of 1 year of romosozumab followed by alendronate versus oral bisphosphonates alone in women with postmenopausal osteoporosis at very high risk for fracture in Canada. Results showed that romosozumab sequenced to alendronate is a cost-effective treatment option, dominating both alendronate and risedronate alone.

Purpose

To demonstrate the value of romosozumab sequenced to alendronate compared to alendronate or risedronate alone, for the treatment of osteoporosis in postmenopausal women with a history of osteoporotic fracture and who are at very high risk for future fracture in Canada.

Methods

A Markov model followed a hypothetical cohort of postmenopausal osteoporotic women at very high risk for future fractures, to estimate the cost-effectiveness of romosozumab and alendronate compared to oral bisphosphonates alone. A total treatment period of 5 years was assumed. Quality-adjusted life years and costs were estimated for each comparator across health states defined by different types of fragility fractures.

Results

Romosozumab/alendronate was associated with a lifetime gain of 0.103 and 0.127 QALYs and a cost reduction of $343 and $3805, relative to alendronate and risedronate, respectively. These results were driven by a reduction of the number of fractures (2561 per 1000 patients, versus 2700 for alendronate and 2724 for risedronate over lifetime). Romosozumab/alendronate had the highest probability of being cost-effective, relative to alendronate and risedronate, at any willingness to pay threshold value.

Conclusion

Romosozumab/alendronate was associated with reduced costs and greater benefit relative to other comparators. Probabilistic, deterministic, and scenario analyses indicate that romosozumab/alendronate represents the best value for money; the uncertainty analyses are robust, and therefore romosozumab should be considered for reimbursement by public drug plans in Canada .

中文翻译：

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romosozumab 在加拿大治疗骨折风险极高的绝经后妇女的成本效益

概括

这项研究评估了在加拿大骨折风险极高的绝经后骨质疏松症女性中，1 年 romosozumab 继以阿仑膦酸盐与单独口服双膦酸盐的成本效益。结果表明，romosozumab 与阿仑膦酸盐进行测序是一种具有成本效益的治疗选择，单独使用阿仑膦酸盐和利塞膦酸盐。

目的

与单独使用阿仑膦酸盐或利塞膦酸盐相比，证明 romosozumab 对阿仑膦酸盐进行测序的价值，用于治疗有骨质疏松性骨折病史且在加拿大未来骨折风险非常高的绝经后妇女的骨质疏松症。

方法

马尔可夫模型跟踪了一组假设的绝经后骨质疏松妇女，这些妇女未来骨折的风险非常高，以估计与单独口服双膦酸盐相比，romosozumab 和阿仑膦酸盐的成本效益。假定总治疗期为 5 年。针对由不同类型的脆性骨折定义的健康状态下的每个比较对象，估计了质量调整生命年和成本。

结果

相对于阿仑膦酸盐和利塞膦酸盐，Romosozumab/阿仑膦酸盐分别与 0.103 和 0.127 QALYs 的终生增益以及 343 美元和 3805 美元的成本降低相关。这些结果是由骨折数量减少推动的（每 1000 名患者中有 2561 人，而阿仑膦酸盐为 2700 人，利塞膦酸盐为 2724 人）。在任何支付阈值的意愿下，与阿仑膦酸盐和利塞膦酸盐相比，Romosozumab/阿仑膦酸盐具有最高成本效益的可能性。

结论

与其他比较药物相比，Romosozumab/阿仑膦酸盐可降低成本并带来更大的获益。概率、确定性和情景分析表明，romosozumab/alendronate 代表了最佳性价比；不确定性分析是可靠的，因此 romosozumab 应考虑由加拿大的公共药物计划报销。