Cost-effectiveness of strontium ranelate in the treatment of male osteoporosis

Abstract

The results of this study suggest that, under the assumption of same relative risk reduction of fractures in men as for women, strontium ranelate could be considered a cost-effective strategy compared with no treatment for the treatment of osteoporotic men from a Belgian healthcare payer perspective.

Introduction: This study was conducted to estimate the cost-effectiveness of strontium ranelate in the treatment of osteoporotic men.

Methods: A previously validated Markov microsimulation model was adapted to estimate the cost (<euro>2,010) per quality-adjusted life-year (QALY) gained of strontium ranelate compared with no treatment. Similar efficacy data on lumbar spine and femoral neck bone mineral density (BMD) between men with osteoporosis at high risk of fracture (MALEO Trial) and postmenopausal osteoporotic women (pivotal SOTI, TROPOS trials) supports the assumption, in the base-case analysis, of the same relative risk reduction of fractures in men as for women. Analyses were conducted, from a Belgian healthcare payer perspective, in the population from the MALEO Trial who is a men population with a mean age of 73 years, and BMD T-score ≤-2.5 or prevalent vertebral fracture (PVF).

Results: In the MALEO population, strontium ranelate compared with no treatment was estimated at <euro>49,798 and <euro>25,584 per QALY gained using efficacy data from the intent-to-treat analysis and the per-protocol analysis including only adherent patients, respectively. In men with a BMD T-score ≤-2.5 or with PVF, the cost per QALY gained of strontium ranelate fall below thresholds of <euro>45,000 and <euro>25,000 per QALY gained based on efficacy data from the entire population of the clinical trial and from the per-protocol analyses, respectively.

Conclusions: The results of this study suggest that, under the assumption of same relative risk reduction of fractures in men as for women, strontium ranelate could be considered cost-effective compared with no treatment for male osteoporosis.

Fig. 1

Potential impact of medication adherence on the cost per QALY gained of strontium ranelate compared with no treatment in men with osteoporosis or prevalent vertebral fracture. BMD bone mineral density ≤−2.5, ITT intention-to-treat, PPS per protocol studies, PVF prevalent vertebral fracture

Fig. 2

Tornado diagram for deterministic sensitivity analyses on the cost-effectiveness of strontium ranelate compared with no treatment in men aged 73 years with BMD T-score ≤−2.5 using efficacy data from the intent-to-treat analysis

Fig. 3

Cost-effectiveness acceptability curves of strontium ranelate compared with no treatment in men aged 73 years with BMD T-score ≤−2.5 according to anti-fracture efficacy. ITT intention-to-treat, PPS per protocol studies