An Updated Systematic Review of Cost-Effectiveness Analyses of Drugs for Osteoporosis

• Published in: PharmacoEconomics 2021-02, Vol.39 (2), p.181-209
• Main Authors: Li, Nannan, Cornelissen, Dennis, Silverman, Stuart, Pinto, Daniel, Si, Lei, Kremer, Ingrid, Bours, Sandrine, de Bot, Robin, Boonen, Annelies, Evers, Silvia, van den Bergh, Joop, Reginster, Jean-Yves, Hiligsmann, Mickaël
• Format: Article
• Language: English
• Subjects: Analysis; Arthritis; Bisphosphonates; Cost analysis; Cost benefit analysis; Drug therapy; Drugs; Fractures; Health Administration; Health Economics; Health services; Human health sciences; Humans; Intervention; Medical care, Cost of; Medicine; Medicine & Public Health; Methods; Monoclonal antibodies; Musculoskeletal diseases; Osteoarthritis; Osteoporosis; Osteoporosis - drug therapy; Osteoporotic Fractures - prevention & control; Patient compliance; Pharmaceutical Preparations; Pharmacoeconomics and Health Outcomes; Population; Public Health; Public health, health care sciences & services; Quality of Life Research; Santé publique, services médicaux & soins de santé; Sciences de la santé humaine; State Medicine; Systematic Review
• ISSN: 1170-7690; 1179-2027; 1179-2027
• DOI: 10.1007/s40273-020-00965-9

Background Considering the heavy economic burden of osteoporotic fractures, the limits of healthcare resources, and the recent availability of new anti-osteoporosis drugs, there is continuing interest in economic evaluation studies of osteoporosis management strategies. Objectives This study aims to (1) systematically review recent economic evaluations of drugs for osteoporosis and (2) to apply an osteoporosis-specific guideline to critically appraise them. Methods A literature search was undertaken using PubMed, EMBASE, National Health Service Economic Evaluation database, and the Cost-Effectiveness Analysis Registry to identify original articles containing economic evaluations of anti-osteoporosis drugs, published between 1 July, 2013 and 31 December, 2019. A recent European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases-International Osteoporosis Foundation (ESCEO-IOF) guideline for the conduct and reporting of economic evaluations in osteoporosis was used to assess the quality of included articles. Results The database search retrieved 3860 records, of which 27 studies fulfilled the inclusion criteria. These studies were conducted in 15 countries; 12 active drugs were assessed, including various traditional pharmacological treatments such as bisphosphonates, raloxifene, strontium ranelate, denosumab, and teriparatide, and new agents such as abaloparatide, romosozumab, and gastro-resistant risedronate. Eight out of 12 studies that compared traditional oral bisphosphonates to other active interventions (denosumab, zoledronic acid, gastro-resistant risedronate, and teriparatide) suggested that the other active agents were generally cost-effective or dominant. Additionally, the cost-effectiveness of sequential therapy has recently been assessed and indications are that it can lead to extra health benefits (larger gains in quality-adjusted life-year). The key drivers of cost effectiveness included baseline fracture risk, drug effect on the risk of fractures, drug cost, and medication adherence/persistence. The current average score for quality assessment was 17 out of 25 (range 2–15); room for improvement was observed for most studies, which could potentially be explained by the fact that most studies were published prior to the osteoporosis-specific guideline. Greater adherence to guideline recommendations was expected for future studies. The quality of reporting was also suboptimal, especially with r