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. 2021 Apr 17;16(1):72.
doi: 10.1007/s11657-021-00891-z.

Cost-effectiveness of sequential daily teriparatide/weekly alendronate compared with alendronate monotherapy for older osteoporotic women with prior vertebral fracture in Japan

Takahiro Mori  1   2   3 , Carolyn J Crandall  4 , Tomoko Fujii  5 , David A Ganz  6   7   8
Affiliations

Cost-effectiveness of sequential daily teriparatide/weekly alendronate compared with alendronate monotherapy for older osteoporotic women with prior vertebral fracture in Japan

Takahiro Mori et al. Arch Osteoporos. .

Abstract

Using a Markov microsimulation model among hypothetical cohorts of community-dwelling older osteoporotic Japanese women with prior vertebral fracture over a lifetime horizon, we found that daily subcutaneous teriparatide for 2 years followed by weekly oral alendronate for 8 years was not cost-effective compared with alendronate monotherapy for 10 years.

Purpose: Teriparatide has proven efficacy in reducing osteoporotic fractures, but with substantial cost. We examined the cost-effectiveness of sequential teriparatide/alendronate (i.e., daily subcutaneous teriparatide for 2 years followed by weekly oral alendronate for 8 years) compared with alendronate monotherapy for 10 years among community-dwelling older osteoporotic women with prior clinical or morphometric vertebral fracture in Japan.

Methods: Using a previously validated and updated Markov microsimulation model, we obtained incremental cost-effectiveness ratios (Japanese yen [¥] (or US dollars [$]) per quality-adjusted life year [QALY]) from the perspective of a single payer responsible for both public healthcare and long-term care. We assumed a lifetime horizon with a willingness-to-pay of ¥5million (or $47,500) per QALY in the base case. We modeled the cost of biosimilar teriparatide, which has been available since November 2019 in Japan, assuming the efficacy was the same as that of the brand version.

Results: In the base case, sequential teriparatide/alendronate was not cost-effective compared with alendronate monotherapy. In deterministic sensitivity analyses, sequential teriparatide/alendronate would become cost-effective with 85%, 50%, and 15% price discounts to teriparatide at ages 70, 75, and 80, respectively, compared to the current biosimilar cost. Otherwise, results were especially sensitive to changes that affected efficacy of teriparatide or alendronate. In probabilistic sensitivity analyses, the probabilities of sequential teriparatide/alendronate being cost-effective were 0%, 1%, and 37% at ages 70, 75, and 80, respectively.

Conclusions: Among high-risk osteoporotic women in Japan, sequential teriparatide/alendronate was not cost-effective compared with alendronate monotherapy, even with the availability of biosimilar teriparatide.

Keywords: Biosimilar; Cost-effectiveness analysis; Fracture prevention; Osteoporosis; Teriparatide.

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Conflict of interest statement

Takahiro Mori: The joint appointment as an associate professor at the University of Tsukuba was sponsored by SMS CO., LTD. in the 2018 financial year (i.e., April 2019 to March 2020), and by FAST DOCTOR CO., LTD in the 2020 financial year (i.e., April 2020 to the present). Neither SMS CO., LTD nor FAST DOCTOR CO., LTD played any role in the conduct of this study.

Carolyn J. Crandall, Tomoko Fujii, and David A. Ganz declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Results of deterministic sensitivity analyses varying the costs of teriparatide at ages 70, 75, and 80
Fig. 2
Fig. 2
Results of probabilistic sensitivity analyses, a: age 70, b: age 75, c: age 80
See this image and copyright information in PMC

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