Value-based pricing of denosumab in secondary prevention of osteoporotic fractures in Chinese post-menopausal women using a validated cost-effectiveness model — ASN Events
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Value-based pricing of denosumab in secondary prevention of osteoporotic fractures in Chinese post-menopausal women using a validated cost-effectiveness model (#204)

Lei Si 1 , Jieruo Gu 2 , Tania Winzenberg 1 , John Eisman 3 , Liudan Tu 2 , Barbara de Graaff 1 , Andrew Palmer 1
  1. University of Tasmania, Hobart, TAS, Australia
  2. Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
  3. Garvan Institute of Medical Research, Sydney, NSW, Australia

Denosumab is cost-effective in osteoporotic fracture prevention in Caucasian populations [1], however, economic evidence is still lacking in China. This study aimed to determine a cost-effective price for denosumab in China, based on its clinical fracture prevention, safety and adherence profile.

Methods: A validated Chinese health economics model of osteoporosis [2] was used to project lifetime costs and effectiveness of secondary fracture prevention with 1)denosumab, and 2)current treatment in China(a mix of calcitonin, alendronate, calcium and vitamin D). Relative risk of hip, vertebral and other fracture with denosumab treatment was assumed at 0.60(95% CI: 0.37-0.97), 0.32(95% CI: 0.26-0.41) and 0.80(95% CI: 0.67-0.95) respectively [3]. First- and second-order Monte-Carlo simulations were conducted in hypothetical Chinese women aged 65years without previous fractures. Patient characteristics were accounted for. Costs were expressed in 2016 US dollars. The willingness-to-pay (WTP) threshold was set at USD 24,000 (3 times per capita GDP in China) per quality-adjusted life year (QALY) gained. The perspective of the health insurance was adopted. Costs and effectiveness were discounted at 3% annually.

Results: Denosumab was cost-effective in Chinese women with a price<$755/injection: lifetime costs and effectiveness for current treatment group were $4,953 and 8.72QALYs and for the denosumab group $8,546(at $755/injection) and 8.87 QALYs. Valued-based pricing conducted in country-specific settings can be used to determine maximum prices at which interventions are cost-effective.

Future works: Denosumab is currently reimbursed in Australia, however this decision was informed by a cost-minimisation analysis that evaluated the non-inferiority of denosumab compared with zoledronic acid [4]. However, cost-effectiveness analysis is more useful by including other important treatment facets such as adherence, adverse events and residual effects after discontinuation of treatment. We are currently adapting the Chinese model to Australia (supported by a National Health and Medical Research Council grant) to systematically evaluate cost-effectiveness of osteoporosis medications in Australia.

  1. Jonsson, B., Strom, O., Eisman, J. A., Papaioannou, A., Siris, E. S., Tosteson, A., & Kanis, J. A. (2011). Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis. Osteoporos Int, 22(3), 967-982.
  2. Si, L., Winzenberg, T. M., Jiang, Q., & Palmer, A. J. (2015). Screening for and treatment of osteoporosis: construction and validation of a state-transition microsimulation cost-effectiveness model. Osteoporos Int, 26(5), 1477-1489.
  3. Cummings , S. R., Martin , J. S., McClung , M. R., Siris , E. S., Eastell , R., Reid , I. R., Delmas , P., Zoog , H. B., Austin , M., Wang , A., Kutilek , S., Adami , S., Zanchetta , J., Libanati , C., Siddhanti , S., & Christiansen , C. (2009). Denosumab for Prevention of Fractures in Postmenopausal Women with Osteoporosis. New England Journal of Medicine, 361(8), 756-765.
  4. PBAC. Denosumab, injection, 60 mg/mL, Prolia® - July 2013. from https://www.pbs.gov.au/pbs/industry/listing/elements/pbac-meetings/psd/2013-07/denosumab