Abaloparatide plus alendronate cost-effective for women at high fracture risk
Sequential therapy featuring abaloparatide followed by alendronate is highly cost-effective for the treatment of women who are at high risk for fractures, compared with teriparatide followed by alendronate, according to data published in Seminars in Arthritis and Rheumatism.
“In the U.S., more than 2 million incident osteoporotic fractures occurred in the year 2015,” Mickael Hiligsmann, PhD, of Maastricht University in the Netherlands, and colleagues wrote. “The total costs of osteoporosis-related fractures were estimated at more than 19 billion U.S. dollars in 2005. Fractures in women accounted for 71% of fractures and 75% of costs overall, while 72% of all costs are related to hip fractures. With an aging population and increasing life expectancy, annual fractures and associated costs are projected to rise by almost 50% by 2025.”
To determine the cost-effectiveness of sequential treatment with abaloparatide (Tymlos, Radius Health) followed by alendronate, as opposed to teriparatide (Forteo, Eli Lilly) followed by alendronate, Hiligsmann and colleagues adopted a previously validated Markov microsimulation model. Using a lifetime horizon, the researchers compared the two regimens, as well as no treatment, assuming patients to receive either abaloparatide or teriparatide for 18 months, followed by alendronate for 5 years.
The researchers used the ACTIVExtend trial to determine fracture risk involved with abaloparatide treatment, with the effects of teriparatide assumed to be maintained during later alendronate therapy, consistent with prior findings related to abaloparatide. The simulated study population included women aged 50 to 80 years with a bone mineral density T-score of –3.5 or less, or with a T-score between –2.5 and –3.5 and a history of at least one osteoporotic fracture.
According to the researchers, abaloparatide followed by alendronate resulted in lower costs and more quality-adjusted life years, compared with the teriparatide-led regimen, in all simulated populations. The researchers added that this was due to improved efficacy and the lower price of abaloparatide. In addition, using probabilistic sensitivity analysis, the researchers found that the abaloparatide-led regimen resulted in lower costs and more quality-adjusted life years in at least 99% of the simulations, and that its gained cost per quality-adjusted life year was always below $130,000, compared with no treatment.
“These findings were robust and confirmed by all the one-way and probabilistic sensitivity analyses,” Hiligsmann and colleagues wrote. “Even when incorporating efficacy data of [teriparatide (TPTD)] from the Fracture Prevention Trial, sequential therapy with [abaloparatide/alendronate (ABL/ALN)] remains the cost-effective treatment alternative. When compared to no treatment, sequential ABL/ALN is cost-effective for women aged 60 years and over, and the [incremental cost-effectiveness ratio] was between $100,000 and $150,000 in women aged 50 years.”
The researchers added “sensitivity analyses on drug prices suggested that ABL/ALN would remain dominant compared to TPTD/ALN even if TPTD price would be reduced by half.” – by Jason Laday
Disclosure: Hiligsmann reports research grants through institution from Amgen, Radius Health and Teva, as well as lecture fees from Radius Health and advisory board payment from UCB. Please see the study for all other authors’ relevant financial disclosures.