Author/Authors :
Ebadi Fard Azar, Amir Ali Medicine School - Iran University of Medical Sciences, Tehran, Iran , Rezapour, Aziz Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Alipour, Vahid Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Sarabi-Asiabar, Ali Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Gray, Serajaddin Department of Health Management and Economics - School of Public Health - Tehran University of Medical Sciences, Tehran, Iran , Mobinizadeh, Mohammadreza National Institute for Health Research - Tehran University of Medical Sciences, Tehran, Iran , Yousefvand, Mani Department of Health Management and Economics - School of Public Health - Tehran University of Medical Sciences, Tehran, Iran , Arabloo, Jalal Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran
Abstract :
Background: Hip, vertebral and wrist fractures are the most common consequences of osteoporosis. This study aimed at analyzing
the cost-effectiveness of teriparatide (CinnoPar®), compared with alendronate and risedronate, in the treatment of women aged 60 and
over with postmenopausal osteoporosis in Iran.
Methods: A decision tree model with a 2-year time horizon was used to compare treatment with teriparatide (CinnoPar®) with the
following treatment strategies: two years of treatment with alendronate and two years of treatment with risedronate in women aged 60
years and over or those at risk of osteoporosis. Cost per QALY was calculated for 3 treatment strategies from the model. After base
case analysis, one-way sensitivity analysis was performed on key parameters of the model to assess their impact on the study results
and the cost-effectiveness of different treatment strategies and the model robustness. TreeAge Pro 2011 software was used for modeling
and data analysis.
Results: Incremental cost-effectiveness ratio (ICER) of alendronate and teriparatide than risedronate (base treatment) were US$-
2178.03 and US$483,783.67 per QALY, respectively. Therefore, the dominant and cost-effective treatment option was alendronate. In
the one-way sensitivity analysis, the impact of annual 25% increase or decrease in the teriparatide cost on its ICER was remarkable.
Also, reducing the discount rate from 0.03 to 0.0 had the greatest impact on the ICER of the teriparatide.
Conclusion: The treatment strategy of teriparatide is more expensive than risedronate and alendronate and is associated with very
little increase in QALYs. A significant reduction in teriparatide price and a limit in its use only for high-risk women and for acute and
short-term treatment courses can contribute to its cost-effectiveness.
Keywords :
Iran , Fracture , Postmenopausal Women , Alendronate , Risedronate , Teriparatide , Cost-effectiveness , Osteoporosis