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<i>Summary</i> <p>In postmenopausal women with osteoporosis, 10-year denosumab was estimated to be cost-effective vs 5&#xa0;years of oral alendronate, a 2-year drug holiday, and subsequently 3-years of alendronate with an estimated incremental cost-effectiveness ratio of $97,574 per quality-adjusted life-years gained. Cost-effectiveness was demonstrated in most of the scenario simulations.</p> Purpose <p>A previous economic analysis estimated that 5-year denosumab was cost-effective compared with 5-year alendronate in women with postmenopausal osteoporosis (PMO) in the United States (US). Emerging literature has provided data on the long-term clinical benefits of denosumab. Therefore, the cost-effectiveness analysis was updated to understand the potential implications of a longer treatment duration (10-year) with denosumab vs generic oral alendronate or no treatment from a US third-party payer perspective.</p> Methods <p>A lifetime Markov cohort model was used to compare 10-year denosumab treatment to 5&#xa0;years of alendronate, followed by a 2-year drug holiday and, then an additional 3&#xa0;years of alendronate. The target population consisted of PMO women in the US with a starting age of 72&#xa0;years. Recent publicly available data, including epidemiology, treatment efficacy, persistence, and costs, were used to inform model inputs. Scenario analyses and a probabilistic sensitivity analysis (PSA) were conducted to account for uncertainty.</p> Results <p>Estimated mean total lifetime cost and quality-adjusted life years (QALYs), respectively, were $81,003 and 8.035 for denosumab, and $75,358 and 7.977 for alendronate, resulting in denosumab having an incremental cost-effectiveness ratio of $97,574 per QALY gained. At a threshold of $150,000 per QALY, the PSA demonstrated that denosumab was considered cost effective in 62.1% of simulations. Denosumab was dominant over no treatment.</p> Conclusions <p>Ten-year denosumab treatment would be cost-effective compared with 5&#xa0;years of alendronate, followed by a 2-year drug holiday and 3&#xa0;years of alendronate at the threshold of $150,000. Cost-effectiveness was demonstrated across most scenarios with robust PSA results.</p>

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A comprehensive update on the cost-effectiveness of 10-year denosumab vs alendronate in postmenopausal women with osteoporosis in the United States

  • 期刊论文

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  • 发表日期：

    2025年6月30日

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  • Eric Yeh,
  • Matia Saeedian,
  • Jack Badaracco

摘要

Summary

In postmenopausal women with osteoporosis, 10-year denosumab was estimated to be cost-effective vs 5 years of oral alendronate, a 2-year drug holiday, and subsequently 3-years of alendronate with an estimated incremental cost-effectiveness ratio of $97,574 per quality-adjusted life-years gained. Cost-effectiveness was demonstrated in most of the scenario simulations.

Purpose

A previous economic analysis estimated that 5-year denosumab was cost-effective compared with 5-year alendronate in women with postmenopausal osteoporosis (PMO) in the United States (US). Emerging literature has provided data on the long-term clinical benefits of denosumab. Therefore, the cost-effectiveness analysis was updated to understand the potential implications of a longer treatment duration (10-year) with denosumab vs generic oral alendronate or no treatment from a US third-party payer perspective.

Methods

A lifetime Markov cohort model was used to compare 10-year denosumab treatment to 5 years of alendronate, followed by a 2-year drug holiday and, then an additional 3 years of alendronate. The target population consisted of PMO women in the US with a starting age of 72 years. Recent publicly available data, including epidemiology, treatment efficacy, persistence, and costs, were used to inform model inputs. Scenario analyses and a probabilistic sensitivity analysis (PSA) were conducted to account for uncertainty.

Results

Estimated mean total lifetime cost and quality-adjusted life years (QALYs), respectively, were $81,003 and 8.035 for denosumab, and $75,358 and 7.977 for alendronate, resulting in denosumab having an incremental cost-effectiveness ratio of $97,574 per QALY gained. At a threshold of $150,000 per QALY, the PSA demonstrated that denosumab was considered cost effective in 62.1% of simulations. Denosumab was dominant over no treatment.

Conclusions

Ten-year denosumab treatment would be cost-effective compared with 5 years of alendronate, followed by a 2-year drug holiday and 3 years of alendronate at the threshold of $150,000. Cost-effectiveness was demonstrated across most scenarios with robust PSA results.