Cost-effectiveness of raloxifene in the treatment of osteoporosis in Chinese postmenopausal women: impact of medication persistence and adherence

Mingsheng Chen, Lei Si, Tania M. Winzenberg, Jieruo Gu, Qicheng Jiang, Andrew J. Palmer

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aims: Raloxifene treatment of osteoporotic fractures is clinically effective, but economic evidence in support of raloxifene reimbursement is lacking in the People’s Republic of China. We aimed at evaluating the cost-effectiveness of raloxifene in the treatment of osteoporotic fractures using an osteoporosis health economic model. We also assessed the impact of medica tion persistence and adherence on clinical outcomes and cost-effectiveness of raloxifene. Methods: We used a previously developed and validated osteoporosis state-transition microsimu lation model to compare treatment with raloxifene with current practices of osteoporotic fracture treatment (conventional treatment) from the health care payer’s perspective. A Monte Carlo probabilistic sensitivity analysis with microsimulations was conducted. The impact of medica tion persistence and adherence on clinical outcomes and the cost-effectiveness of raloxifene was addressed in sensitivity analyses. The simulated patients used in the model’s initial state were 65-year-old postmenopausal Chinese women with osteoporosis (but without previous fractures), simulated using a 1-year cycle length until all patients had died. Costs were presented in 2015 US dollars (USD), and costs and effectiveness were discounted at 3% annually. The willingness to-pay threshold was set at USD 20,000 per quality-adjusted life year (QALY) gained. Results: Treatment with raloxifene improved clinical effectiveness by 0.006 QALY, with additional costs of USD 221 compared with conventional treatment. The incremental cost effectiveness ratio was USD 36,891 per QALY gained. The cost-effectiveness decision did not change in most of the one-way sensitivity analyses. With full raloxifene persistence and adherence, average effectiveness improved compared with the real-world scenario, and the incremental cost effectiveness ratio was USD 40,948 per QALY gained compared with conventional treatment. Conclusion: Given the willingness-to-pay threshold, raloxifene treatment was not cost-effective for treatment of osteoporotic fractures in postmenopausal Chinese women. Medication persis tence and adherence had a great impact on clinical and cost-effectiveness, and therefore should be incorporated in future pharmacoeconomic studies of osteoporosis interventions.

LanguageEnglish
Pages415-423
Number of pages9
JournalPatient Preference and Adherence
Volume10
DOIs
Publication statusPublished - 29 Mar 2016
Externally publishedYes

Fingerprint

bone disease
Medication Adherence
Osteoporosis
Cost-Benefit Analysis
persistence
medication
Osteoporotic Fractures
Quality-Adjusted Life Years
costs
dollar
Therapeutics
willingness to pay
Economic Models
Raloxifene Hydrochloride
Costs and Cost Analysis
Pharmaceutical Economics
Health Care Costs
economic model
China
Economics

Bibliographical note

Copyright 2016 Chen et al. This work is published and licensed by Dove Medical Press Limited. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • Adherence
  • Chinese
  • Cost-effectiveness
  • Persistence
  • Postmenopausal osteoporosis

Cite this

Chen, Mingsheng ; Si, Lei ; Winzenberg, Tania M. ; Gu, Jieruo ; Jiang, Qicheng ; Palmer, Andrew J. / Cost-effectiveness of raloxifene in the treatment of osteoporosis in Chinese postmenopausal women : impact of medication persistence and adherence. In: Patient Preference and Adherence. 2016 ; Vol. 10. pp. 415-423.
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abstract = "Aims: Raloxifene treatment of osteoporotic fractures is clinically effective, but economic evidence in support of raloxifene reimbursement is lacking in the People’s Republic of China. We aimed at evaluating the cost-effectiveness of raloxifene in the treatment of osteoporotic fractures using an osteoporosis health economic model. We also assessed the impact of medica tion persistence and adherence on clinical outcomes and cost-effectiveness of raloxifene. Methods: We used a previously developed and validated osteoporosis state-transition microsimu lation model to compare treatment with raloxifene with current practices of osteoporotic fracture treatment (conventional treatment) from the health care payer’s perspective. A Monte Carlo probabilistic sensitivity analysis with microsimulations was conducted. The impact of medica tion persistence and adherence on clinical outcomes and the cost-effectiveness of raloxifene was addressed in sensitivity analyses. The simulated patients used in the model’s initial state were 65-year-old postmenopausal Chinese women with osteoporosis (but without previous fractures), simulated using a 1-year cycle length until all patients had died. Costs were presented in 2015 US dollars (USD), and costs and effectiveness were discounted at 3{\%} annually. The willingness to-pay threshold was set at USD 20,000 per quality-adjusted life year (QALY) gained. Results: Treatment with raloxifene improved clinical effectiveness by 0.006 QALY, with additional costs of USD 221 compared with conventional treatment. The incremental cost effectiveness ratio was USD 36,891 per QALY gained. The cost-effectiveness decision did not change in most of the one-way sensitivity analyses. With full raloxifene persistence and adherence, average effectiveness improved compared with the real-world scenario, and the incremental cost effectiveness ratio was USD 40,948 per QALY gained compared with conventional treatment. Conclusion: Given the willingness-to-pay threshold, raloxifene treatment was not cost-effective for treatment of osteoporotic fractures in postmenopausal Chinese women. Medication persis tence and adherence had a great impact on clinical and cost-effectiveness, and therefore should be incorporated in future pharmacoeconomic studies of osteoporosis interventions.",
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Cost-effectiveness of raloxifene in the treatment of osteoporosis in Chinese postmenopausal women : impact of medication persistence and adherence. / Chen, Mingsheng; Si, Lei; Winzenberg, Tania M.; Gu, Jieruo; Jiang, Qicheng; Palmer, Andrew J.

In: Patient Preference and Adherence, Vol. 10, 29.03.2016, p. 415-423.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Cost-effectiveness of raloxifene in the treatment of osteoporosis in Chinese postmenopausal women

T2 - Patient Preference and Adherence

AU - Chen, Mingsheng

AU - Si, Lei

AU - Winzenberg, Tania M.

AU - Gu, Jieruo

AU - Jiang, Qicheng

AU - Palmer, Andrew J.

N1 - Copyright 2016 Chen et al. This work is published and licensed by Dove Medical Press Limited. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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Y1 - 2016/3/29

N2 - Aims: Raloxifene treatment of osteoporotic fractures is clinically effective, but economic evidence in support of raloxifene reimbursement is lacking in the People’s Republic of China. We aimed at evaluating the cost-effectiveness of raloxifene in the treatment of osteoporotic fractures using an osteoporosis health economic model. We also assessed the impact of medica tion persistence and adherence on clinical outcomes and cost-effectiveness of raloxifene. Methods: We used a previously developed and validated osteoporosis state-transition microsimu lation model to compare treatment with raloxifene with current practices of osteoporotic fracture treatment (conventional treatment) from the health care payer’s perspective. A Monte Carlo probabilistic sensitivity analysis with microsimulations was conducted. The impact of medica tion persistence and adherence on clinical outcomes and the cost-effectiveness of raloxifene was addressed in sensitivity analyses. The simulated patients used in the model’s initial state were 65-year-old postmenopausal Chinese women with osteoporosis (but without previous fractures), simulated using a 1-year cycle length until all patients had died. Costs were presented in 2015 US dollars (USD), and costs and effectiveness were discounted at 3% annually. The willingness to-pay threshold was set at USD 20,000 per quality-adjusted life year (QALY) gained. Results: Treatment with raloxifene improved clinical effectiveness by 0.006 QALY, with additional costs of USD 221 compared with conventional treatment. The incremental cost effectiveness ratio was USD 36,891 per QALY gained. The cost-effectiveness decision did not change in most of the one-way sensitivity analyses. With full raloxifene persistence and adherence, average effectiveness improved compared with the real-world scenario, and the incremental cost effectiveness ratio was USD 40,948 per QALY gained compared with conventional treatment. Conclusion: Given the willingness-to-pay threshold, raloxifene treatment was not cost-effective for treatment of osteoporotic fractures in postmenopausal Chinese women. Medication persis tence and adherence had a great impact on clinical and cost-effectiveness, and therefore should be incorporated in future pharmacoeconomic studies of osteoporosis interventions.

AB - Aims: Raloxifene treatment of osteoporotic fractures is clinically effective, but economic evidence in support of raloxifene reimbursement is lacking in the People’s Republic of China. We aimed at evaluating the cost-effectiveness of raloxifene in the treatment of osteoporotic fractures using an osteoporosis health economic model. We also assessed the impact of medica tion persistence and adherence on clinical outcomes and cost-effectiveness of raloxifene. Methods: We used a previously developed and validated osteoporosis state-transition microsimu lation model to compare treatment with raloxifene with current practices of osteoporotic fracture treatment (conventional treatment) from the health care payer’s perspective. A Monte Carlo probabilistic sensitivity analysis with microsimulations was conducted. The impact of medica tion persistence and adherence on clinical outcomes and the cost-effectiveness of raloxifene was addressed in sensitivity analyses. The simulated patients used in the model’s initial state were 65-year-old postmenopausal Chinese women with osteoporosis (but without previous fractures), simulated using a 1-year cycle length until all patients had died. Costs were presented in 2015 US dollars (USD), and costs and effectiveness were discounted at 3% annually. The willingness to-pay threshold was set at USD 20,000 per quality-adjusted life year (QALY) gained. Results: Treatment with raloxifene improved clinical effectiveness by 0.006 QALY, with additional costs of USD 221 compared with conventional treatment. The incremental cost effectiveness ratio was USD 36,891 per QALY gained. The cost-effectiveness decision did not change in most of the one-way sensitivity analyses. With full raloxifene persistence and adherence, average effectiveness improved compared with the real-world scenario, and the incremental cost effectiveness ratio was USD 40,948 per QALY gained compared with conventional treatment. Conclusion: Given the willingness-to-pay threshold, raloxifene treatment was not cost-effective for treatment of osteoporotic fractures in postmenopausal Chinese women. Medication persis tence and adherence had a great impact on clinical and cost-effectiveness, and therefore should be incorporated in future pharmacoeconomic studies of osteoporosis interventions.

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