An Updated Systematic Review of Cost-Effectiveness Analyses of Drugs for Osteoporosis
- PMID: 33026634
- PMCID: PMC7867562
- DOI: 10.1007/s40273-020-00965-9
An Updated Systematic Review of Cost-Effectiveness Analyses of Drugs for Osteoporosis
Abstract
Background: Considering the heavy economic burden of osteoporotic fractures, the limits of healthcare resources, and the recent availability of new anti-osteoporosis drugs, there is continuing interest in economic evaluation studies of osteoporosis management strategies.
Objectives: This study aims to (1) systematically review recent economic evaluations of drugs for osteoporosis and (2) to apply an osteoporosis-specific guideline to critically appraise them.
Methods: A literature search was undertaken using PubMed, EMBASE, National Health Service Economic Evaluation database, and the Cost-Effectiveness Analysis Registry to identify original articles containing economic evaluations of anti-osteoporosis drugs, published between 1 July, 2013 and 31 December, 2019. A recent European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases-International Osteoporosis Foundation (ESCEO-IOF) guideline for the conduct and reporting of economic evaluations in osteoporosis was used to assess the quality of included articles.
Results: The database search retrieved 3860 records, of which 27 studies fulfilled the inclusion criteria. These studies were conducted in 15 countries; 12 active drugs were assessed, including various traditional pharmacological treatments such as bisphosphonates, raloxifene, strontium ranelate, denosumab, and teriparatide, and new agents such as abaloparatide, romosozumab, and gastro-resistant risedronate. Eight out of 12 studies that compared traditional oral bisphosphonates to other active interventions (denosumab, zoledronic acid, gastro-resistant risedronate, and teriparatide) suggested that the other active agents were generally cost-effective or dominant. Additionally, the cost-effectiveness of sequential therapy has recently been assessed and indications are that it can lead to extra health benefits (larger gains in quality-adjusted life-year). The key drivers of cost effectiveness included baseline fracture risk, drug effect on the risk of fractures, drug cost, and medication adherence/persistence. The current average score for quality assessment was 17 out of 25 (range 2-15); room for improvement was observed for most studies, which could potentially be explained by the fact that most studies were published prior to the osteoporosis-specific guideline. Greater adherence to guideline recommendations was expected for future studies. The quality of reporting was also suboptimal, especially with regard to treatment side effects, treatment effect after discontinuation, and medication adherence.
Conclusions: This updated review provides an overview of recently published cost-effectiveness analyses. In comparison with a previous review, recent economic evaluations of anti-osteoporosis drugs were conducted in more countries and included more active drugs and sequential therapy as interventions/comparators. The updated economic evidence could help decision makers prioritize health interventions and the unmet/unreported quality issues indicated by the osteoporosis-specific guideline could be useful in improving the transparency, quality, and comparability of future economic evaluations in osteoporosis.
Conflict of interest statement
Nannan Li is funded by the China Scholarship Council (grant number 201909110080). Lei Si is funded by a National Health and Medical Research Council Early Career Fellowship (grant number GNT1139826). Mickaël Hiligsmann has received research grants through institutions from Amgen, Bayer, Radius Health, and ViiV-Healthcare GSK. Anneleis Boonen received a research grant from Abbvie and Celgene, and honorariums from UCF, Lilly, and Galapagos. Jean-Yves Reginster has served on paid advisory boards, and received consulting fees, lecture fees, and/or grant support from IBSA-Genevrier, Mylan, Radius Health, Pierre Fabre, Echolight, Teva, Cniel, and the Dairy Research Council.
Figures
![Fig. 1](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/7867562/bin/40273_2020_965_Fig1_HTML.gif)
![Fig. 2](https://cdn.statically.io/img/www.ncbi.nlm.nih.gov/pmc/articles/instance/7867562/bin/40273_2020_965_Fig2_HTML.gif)
Similar articles
-
Cost Effectiveness Analyses of Interventions for Osteoporosis in Men: A Systematic Literature Review.Pharmacoeconomics. 2023 Apr;41(4):363-391. doi: 10.1007/s40273-022-01239-2. Epub 2023 Feb 4. Pharmacoeconomics. 2023. PMID: 36738425 Free PMC article.
-
A systematic review of cost‑effectiveness analyses of sequential treatment for osteoporosis.Osteoporos Int. 2023 Apr;34(4):641-658. doi: 10.1007/s00198-022-06626-1. Epub 2022 Dec 17. Osteoporos Int. 2023. PMID: 36527476 Review.
-
Cost-effectiveness analyses of denosumab for osteoporosis: a systematic review.Osteoporos Int. 2022 May;33(5):979-1015. doi: 10.1007/s00198-021-06268-9. Epub 2022 Jan 21. Osteoporos Int. 2022. PMID: 35059777 Review.
-
Denosumab, raloxifene, romosozumab and teriparatide to prevent osteoporotic fragility fractures: a systematic review and economic evaluation.Health Technol Assess. 2020 Jun;24(29):1-314. doi: 10.3310/hta24290. Health Technol Assess. 2020. PMID: 32588816 Free PMC article.
-
A systematic review of cost-effectiveness analyses of drugs for postmenopausal osteoporosis.Pharmacoeconomics. 2015 Mar;33(3):205-24. doi: 10.1007/s40273-014-0231-1. Pharmacoeconomics. 2015. PMID: 25377850 Review.
Cited by
-
Epidemiology of hip fractures in Thailand.Osteoporos Int. 2024 Jun 4. doi: 10.1007/s00198-024-07140-2. Online ahead of print. Osteoporos Int. 2024. PMID: 38832991
-
Asia-Pacific consensus on long-term and sequential therapy for osteoporosis.Osteoporos Sarcopenia. 2024 Mar;10(1):3-10. doi: 10.1016/j.afos.2024.02.001. Epub 2024 Mar 16. Osteoporos Sarcopenia. 2024. PMID: 38690538 Free PMC article. Review.
-
The cost-effectiveness of osteoporosis medications for preventing periprosthetic fractures following femoral neck fracture indicated hip arthroplasty: a break-even analysis.Osteoporos Int. 2024 Jul;35(7):1223-1229. doi: 10.1007/s00198-024-07085-6. Epub 2024 Apr 15. Osteoporos Int. 2024. PMID: 38619605
-
The role and impact of health economics in the optimization of patient care in osteoarthritis: insights from a practical example.Glob Reg Health Technol Assess. 2024 Apr 3;11:75-81. doi: 10.33393/grhta.2024.2682. eCollection 2024 Jan-Dec. Glob Reg Health Technol Assess. 2024. PMID: 38601071 Free PMC article.
-
Mechanism exploration of Zoledronic acid combined with PD-1 in the treatment of hepatocellular carcinoma.Cancer Immunol Immunother. 2024 Mar 2;73(4):62. doi: 10.1007/s00262-024-03652-2. Cancer Immunol Immunother. 2024. PMID: 38430249 Free PMC article.
References
-
- Morizio P, Burkhart JI, Ozawa S. Denosumab: a unique perspective on adherence and cost-effectiveness compared with oral bisphosphonates in osteoporosis patients. Ann Pharmacother. 2018;52(10):1031–1041. - PubMed
-
- Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–1733. - PubMed
-
- Parthan A, Kruse M, Yurgin N, Huang J, Viswanathan HN, Taylor D. Cost effectiveness of denosumab versus oral bisphosphonates for postmenopausal osteoporosis in the US. Appl Health Econ Health Policy. 2013;11(5):485–497. - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical