Cost-utility analysis of drugs for secondary bone fracture prevention among post-menopausal osteoporotic patients in Thailand

Abstract

This study assessed the cost utility of medications used to prevent recurrent bone fractures among post-menopausal osteoporotic Thai women with a history of fractures. Economic evaluation was conducted using the Markov model-based cost-utility analysis approach under the societal perspective. Women age 50 and over with bone mass density T-score of less than or equal to 2.5 standard deviations and a history of fractures were included in the model, with a 1-year cycle length, until deceased. The model compared the expected costs and outcomes of calcium plus vitamin D alone (standard regimen) with those of calcium plus vitamin D with adjunct bisphosphonates (alendronate or risedronate), raloxifene, strontium, denosumab, or teriparatide. Bisphosphonates provided added health benefits whereas the other drugs did not. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained were approximately 92,995 Baht (US$2,997) for bisphosphonates and 1,701,932 Baht (US$54,848) for denosumab. Teriparatide was the most expensive with an ICER of 10,354,673 Baht (US$333,699) per QALY gained. The cost of drugs was the major expense. In conclusion, bisphosphonates are the most cost-effective adjunct interventions for post-menopausal osteoporotic women with a history of fractures treated under the Thai healthcare system.