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]
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/
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 Type:||Refereed Article|
|Keywords:||Chinese, adherence, cost-effectiveness, persistence, postmenopausal osteoporosis|
|Research Group:||Applied economics|
|Research Field:||Health economics|
|Objective Group:||Evaluation of health and support services|
|Objective Field:||Evaluation of health and support services not elsewhere classified|
|UTAS Author:||Si, L (Mr Lei Si)|
|UTAS Author:||Winzenberg, TM (Professor Tania Winzenberg)|
|UTAS Author:||Palmer, AJ (Professor Andrew Palmer)|
|Web of Science® Times Cited:||4|
|Deposited By:||Menzies Institute for Medical Research|
|Downloads:||147 View Download Statistics|
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