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

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Chen, M and Si, L and Winzenberg, TM and Gu, J and Jiang, Q and Palmer, AJ, Cost-effectiveness of raloxifene in the treatment of osteoporosis in Chinese postmenopausal women: impact of medication persistence and adherence, Patient Preference and Adherence, 10 pp. 415-423. ISSN 1177-889X (2016) [Refereed Article]


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Copyright 2016 Chen et al. Licensed under Creative Commons Attribution-NonCommercial 3.0 Unported (CC BY-NC 3.0) https://creativecommons.org/licenses/by-nc/3.0/

DOI: doi:10.2147/PPA.S100175

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 medication persistence and adherence on clinical outcomes and cost-effectiveness of raloxifene.

METHODS: We used a previously developed and validated osteoporosis state-transition microsimulation 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 medication 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 persistence and adherence had a great impact on clinical- and cost-effectiveness, and therefore should be incorporated in future pharmacoeconomic studies of osteoporosis interventions.

Item Details

Item Type:Refereed Article
Keywords:Chinese, adherence, cost-effectiveness, persistence, postmenopausal osteoporosis
Research Division:Economics
Research Group:Applied Economics
Research Field:Health Economics
Objective Division:Health
Objective Group:Health and Support Services
Objective Field:Health Policy Economic Outcomes
Author:Si, L (Mr Lei Si)
Author:Winzenberg, TM (Professor Tania Winzenberg)
Author:Palmer, AJ (Professor Andrew Palmer)
ID Code:108752
Year Published:2016
Web of Science® Times Cited:1
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-05-05
Last Modified:2017-11-03
Downloads:52 View Download Statistics

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