폐경기 골다공증 환자에서 데노수맙 사용에 대한 비용-효과 분석
Cost-Effectiveness of Denosumab for Post-Menopausal Osteoporosis in South Korea
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초록
Background: In South Korea, 22.3% of women ≥50 years of age and 37% of women ≥70 years of age visit the doctor to obtaintreatment for osteoporosis. According to the analysis of the National Health Insurance Services claim data between 2008 and 2012,the number and incidence of hip and vertebral fractures increased during the same period. Denosumab, a newly marketedmedicine in Korea, is the first RANK inhibitor. Methods: A cost-utility analysis was conducted from a societal perspective to provethe superiority of denosumab to alendronate. A Markov cohort model was used to investigate the cost-effectiveness of denosumab. A 6-month cycle length was used in the model, and all patients were individually followed up through the model, from their age attreatment initiation to their time of death or until 100 years of age. The model consisted of eight health states: well; hip fracture;vertebral fracture; wrist fracture; other osteoporotic fracture; post-hip fracture; post-vertebral fracture; and dead. All patients beganin the well-health state. In this model, 5% discounted rate, two-year maximum offset time, and persistence were adopted. Results:The total lifetime costs for alendronate and denosumab were USD 5,587 and USD 6,534, respectively. The incremental costeffectivenessratio (ICER) for denosumab versus alendronate was USD 20,600/QALY. Given the ICER threshold in Korea, the resultsindicated that denosumab was remarkably superior to alendronate. Conclusion: Denosumab is a cost-effective alternative to theoral anti-osteoporotic treatment, alendronate, in South Korea.
Abstract
Background: In South Korea, 22.3% of women ≥50 years of age and 37% of women ≥70 years of age visit the doctor to obtaintreatment for osteoporosis. According to the analysis of the National Health Insurance Services claim data between 2008 and 2012,the number and incidence of hip and vertebral fractures increased during the same period. Denosumab, a newly marketedmedicine in Korea, is the first RANK inhibitor. Methods: A cost-utility analysis was conducted from a societal perspective to provethe superiority of denosumab to alendronate. A Markov cohort model was used to investigate the cost-effectiveness of denosumab. A 6-month cycle length was used in the model, and all patients were individually followed up through the model, from their age attreatment initiation to their time of death or until 100 years of age. The model consisted of eight health states: well; hip fracture;vertebral fracture; wrist fracture; other osteoporotic fracture; post-hip fracture; post-vertebral fracture; and dead. All patients beganin the well-health state. In this model, 5% discounted rate, two-year maximum offset time, and persistence were adopted. Results:The total lifetime costs for alendronate and denosumab were USD 5,587 and USD 6,534, respectively. The incremental costeffectivenessratio (ICER) for denosumab versus alendronate was USD 20,600/QALY. Given the ICER threshold in Korea, the resultsindicated that denosumab was remarkably superior to alendronate. Conclusion: Denosumab is a cost-effective alternative to theoral anti-osteoporotic treatment, alendronate, in South Korea.
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