Cost-effectiveness of bazedoxifene incorporating the FRAX® algorithm in a European perspective

• Published in: Osteoporosis international Vol. 22; no. 3; pp. 955 - 965
• Main Authors: Borgström, F, Ström, O, Kleman, M, McCloskey, E, Johansson, H, Odén, A, Kanis, J. A
• Format: Journal Article
• Language: English
• Published: London London : Springer-Verlag 01-03-2011; Springer-Verlag; Springer; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Algorithms; Biological and medical sciences; Bone mineral density; Clinical risk factor; Cost-Benefit Analysis; Diseases of the osteoarticular system; Drug therapy; Efficacy; Endocrinology; Estrogens; Europe - epidemiology; Female; Fracture; Fractures; Health care; Health Care Costs; Health care expenditures; Health risk assessment; Humans; Indoles - economics; Indoles - therapeutic use; Injuries of the limb. Injuries of the spine; Markov Chains; Medical sciences; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Original Article; Orthopedics; Osteoporosis; Osteoporosis, Postmenopausal - drug therapy; Osteoporosis, Postmenopausal - economics; Osteoporosis. Osteomalacia. Paget disease; Osteoporotic Fractures - economics; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - prevention & control; Quality-Adjusted Life Years; Rheumatology; risk; Risk assessment; Risk Assessment - economics; Risk Assessment - methods; Risk factors; Risk reduction; Selective Estrogen Receptor Modulators - economics; Selective Estrogen Receptor Modulators - therapeutic use; SERM; Traumas. Diseases due to physical agents; Treatment Outcome; Europe; Osteoporosis; Efficacy; Risk; Fracture; Clinical risk factor; SERM; Costs; Bazedoxifene; Diseases of the osteoarticular system; Rheumatology; Trauma; Algorithm; Health economy; Risk factor; Public health
• DOI: 10.1007/s00198-010-1291-5
• EISSN: 1433-2965
• ISSN: 0937-941X; 1433-2965

Summary The cost-effectiveness of bazedoxifene was compared to placebo in France, Germany, Italy, Spain, Sweden and the UK from a healthcare perspective using FRAX® for both fracture risks and for treatment efficacy. Cost/QALY differences were explained to a large extent by differences in fracture risk. Introduction In cost-effectiveness modelling of osteoporosis treatments, the fracture risk has traditionally been calculated with risk adjustments based on age, bone mineral density and prior fracture. However, knowledge of additional clinical risk factors contributes to fracture risk assessment as demonstrated by the FRAX® tool. Bazedoxifene, a new selective estrogen receptor modulator for the treatment and prevention of osteoporosis, has been shown in a phase III clinical trial to reduce the risk of osteoporotic fractures in women. In an analysis using FRAX®, the efficacy of bazedoxifene was greater in patients with higher fracture risk. Methods The aim of this study was to evaluate the cost-effectiveness of bazedoxifene compared to placebo in France, Germany, Italy, Spain, Sweden and the UK from a healthcare perspective using FRAX®. A Markov cohort model was adapted to incorporate the FRAX® risk factors. FRAX® produces relative risks for hip fractures and major osteoporotic fractures. Patients were given a 5-year intervention, reducing the risk of fractures in a risk-dependent manner. The effect of treatment on fractures was assumed to decline linearly over 5 years after the intervention. Results There are large cost/quality-adjusted life year variations between countries in the European setting studied. The base case values ranged from cost saving (Sweden) to EUR 105,450 (Spain) in 70-year-old women with a T-score of −2.5 SD and a prior fracture. Conclusion Bazedoxifene can be a cost-effective treatment for postmenopausal osteoporosis. The variability between countries was explained to a large extent by differences in fracture risk, and the estimated cost-effectiveness was highly dependent on the population's FRAX®-estimated probability of major osteoporotic fracture.