Cost-effectiveness comparison of Denosumab and Zoledronic Acid in the treatment of Postmenopausal Osteoporosis
Objective: To evaluate the cost-effectiveness of denosumab (Prolia®, 60 mg every 6 month) compared to generic zoledronic acid (5 mg once yearly) in the treatment of postmenopausal osteoporosis in the U.S. societal perspective.
Background: Osteoporotic fractures are a huge economic burden on the U.S. society. Zoledronic acid and denosumab are the “first-line therapies” for the treatment of postmenopausal osteoporosis recommended by AACE Guidelines, and generic zoledronic acid has been recently launched. This study helps fill a gap in the economic assessment of these two relatively new first-line therapies for postmenopausal osteoporosis. The comparison will be of interest to patients, healthcare providers and policy makers.
Data sources: Comprehensive literature and online search was employed to obtain data on the clinical effectiveness of drugs, health-related quality of life (HRQoL) of disease states and costs. Databases searched were PubMed and Google Scholar engine.
Method: A Markov cohort model was constructed within the framework of incremental cost effectiveness ratios (ICERs) and net monetary benefit analyses. Given that generic zoledronic acid dominates denosumab in the base-case scenario, only one-way sensitivity analyses were performed to evaluate the sensitivity of results to model parameters. Finally, threshold analyses were used to determine the price at which denosumab would be as cost-effective as generic zoledronic acid.
Results: Generic zoledronic acid dominates denosumab in the base-case scenario and one-way sensitivity analyses. Even at a zero price, denosumab would not be cost effective relative to generic zolendronic acid.
Conclusion: Based on a U.S. societal perspective, generic zoledronic acid is more cost-effective than denosumab in the treatment of high-risk patients with postmenopausal osteoporosis.
Keywords: Postmenopausal Osteoporosis; Cost-effectiveness; Markov Model; zoledronic acid; denosumab