AUTHOR=You Ruxu , Liu Jinyu , Ke Lei , Yu Guangyi , Zhang Yu , Mori Takahiro 

TITLE=Cost-Effectiveness of Sequential Teriparatide/Zoledronic Acid Compared With Zoledronic Acid Monotherapy for Postmenopausal Osteoporotic Women in China

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.794861

DOI=10.3389/fpubh.2022.794861

ISSN=2296-2565

ABSTRACT=Objective: The aim of this study was to evaluate the cost-effectiveness of sequential teriparatide/zoledronic acid compared with zoledronic acid monotherapy for postmenopausal osteoporotic women in China.
Methods: An updated version of the previously validated Markov microsimulation model was used to examine the cost-effectiveness of daily subcutaneous teriparatide for 2 years followed by annual intravenous zoledronic acid for 3 years (sequential teriparatide/zoledronic acid), compared with zoledronic acid monotherapy for 3 years in Chinese women with postmenopausal osteoporosis at ages 65, 70, 75, and 80 from the health care payer perspective.
Results: The incremental cost-effectiveness ratios (ICERs) (US dollars [$] per quality-adjusted life-year [QALY]) of sequential teriparatide/zoledronic acid versus zoledronic acid monotherapy was $173,223/ QALY at age 65 years, which was much higher than the pre-determined willingness-to-pay (WTP) threshold of $ 31,512/QALY, and the results were similar at other ages. One-way sensitivity analysis indicated that the most influential parameters were the cost of teriparatide and the residual effect for the different treatments modelled. Sequential teriparatide/zoledronic acid became cost-effective at age 80 with the cost of teriparatide reduced by 50%. Without the residual effect, the ICER increased to $257,982/QALY. In probabilistic sensitivity analyses, the probabilities of zoledronic acid monotherapy being cost-effective were 100% at a WTP of $31,512/QALY.
Conclusions: Among postmenopausal osteoporotic women in China, sequential teriparatide/zoledronic acid was not cost-effective unless the cost of teriparatide was reduced by 50% only for the participants over 80 years.