Cost-Effectiveness of Sequential Abaloparatide/Alendronate in Men at High Risk of Fractures in the United States

• DOI: 10.1007/s40273-023-01270-x
• Publication Date: 2023-04-22T12:01:50Z
• Authors: Mickaël Hiligsmann; Stuart S. Silverman; Andrea J. Singer; Leny Pearman; Jake Mathew; Yamei Wang; John Caminis; Jean-Yves Reginster
• Keywords: Teriparatide

Abaloparatide (ABL) significantly increases bone mineral density in men with osteoporosis similar to what was reported postmenopausal women osteoporosis. The cost effectiveness of sequential treatment ABL followed by alendronate (ALN) at high fracture risk compared relevant alternative treatments. A Markov-based microsimulation model based on a lifetime US healthcare decision maker perspective developed evaluate the (expressed US$2021) per quality-adjusted life-years (QALYs) gained ABL/ALN. Comparators were unbranded teriparatide (TPTD)/ALN, generic ALN monotherapy, and no treatment. Discount rates 3% used. Consistent practice guidelines, patients received 18 months or TPTD for 5 years, years monotherapy. Analyses conducted high-risk aged over 50 defined as having T-score ≤−2.5 recent fracture. Time-specific subsequent after fracture, incremental costs up following fractures, real-world medication adherence, mostly men-specific data included model. One-way probabilistic sensitivity analyses assess robustness results. Over full age range, ABL/ALN led more QALYs lower than TPTD/ALN, while dominated (more QALYs, costs) QALY threshold US$150,000 versus probabilities that effective monotherapy estimated 51% between 88 90% those ≥ 60 years. Sequential therapy using may be risk, especially Unbranded TPTD/ALN interventions (less QALY,