进行了基于模型的成本效益分析,以评估实施糖皮质激素诱导的骨质疏松症(GIO)治疗临床指南的成本效益。当前日本临床指南中GIO的治疗适应症可能具有成本效益,除了骨折风险低的有限患者。
背景:本研究的目的是从日本医疗保健系统的角度评估实施糖皮质激素诱导的骨质疏松症(GIO)治疗临床指南的成本效益。
方法:开发了一种患者水平状态转变模型,用于预测使用糖皮质激素(GC)的绝经后骨质减少或骨质疏松的日本女性的终生成本和质量调整生命年(QALYs)。对成本和QALY均采用2%的年度贴现率。5年阿仑膦酸钠治疗与无治疗相比的增量成本-效果比(ICER)是根据不同的风险因素组合进行估计的,例如起始年龄(45、55或65)。股骨颈骨密度(年轻成人平均值(YAM)为70%,75%,或80%),剂量的GC(每天2.5、5或10mg),和先前骨折的存在(是或否)。
结果:对于使用GC且BMD为YAM的75%的55岁女性,ICER从每QALY10958美元到29727美元不等。情景分析表明,年龄越低,较低的BMD,GC的剂量越高,以及与较低ICER相关的先前骨折的存在。最好的情况是45岁的女性,其BMD为YAM的70%,每天10毫克的GC剂量,和以前的骨折,并节省了医疗保健成本。最坏的情况是65岁的女性,其BMD为YAM的80%,GC剂量为每天2.5mg,以前没有骨折,并导致每个QALY的ICER为66,791美元。在最坏情况下的敏感性分析表明,成本和健康福利的年度贴现率对估计的ICER有很大影响。尽管ICER受到其他参数的影响,例如由于椎骨骨折而导致的不灵活性,阿仑膦酸钠的功效,等等,ICER每个QALY仍然超过50,000美元。
结论:使用GC预防性阿仑膦酸钠治疗绝经后骨质减少或骨质疏松妇女的成本效益对年龄敏感,BMD,GC剂量,和先前骨折的存在。我们的分析表明,在当前的日本临床指南中,使用GC治疗绝经后骨量减少或骨质疏松症的妇女的适应症可能具有成本效益,除了有限的患者骨折风险低。
A model-based cost-effectiveness analysis was performed to evaluate the cost-effectiveness of implementing the clinical
guideline for the treatment for glucocorticoid-induced osteoporosis (GIO). The treatment indication for GIO in the current Japanese clinical
guidelines is likely to be cost-effective except for the limited patients who are at low risk for fracture.
BACKGROUND: The purpose of this study was to evaluate the cost-effectiveness of implementing the clinical
guideline for the treatment for glucocorticoid-induced osteoporosis (GIO) from the perspective of the Japanese healthcare system.
METHODS: A patient-level state transition model was developed to predict lifetime costs and quality-adjusted life years (QALYs) in postmenopausal Japanese women with osteopenia or osteoporosis using glucocorticoid (GC). An annual discount rate of 2% for both costs and QALYs was applied. The incremental cost-effectiveness ratio (ICER) of 5-year alendronate therapy compared with no therapy was estimated with different combinations of the risk factors such as starting age (45, 55, or 65), femoral neck BMD (% young adult mean (YAM) of 70%, 75%, or 80%), dose of GC (2.5, 5, or 10 mg per day), and the presence of previous fracture (yes or no).
RESULTS: For 55-year-old women using GC with a BMD of 75% of YAM, the ICER ranged from $10,958 to $ 29,727 per QALY. Scenario analyses indicated that the lower age, the lower BMD, the higher dose of GC, and the presence of previous fracture associated with lower ICER. The best-case scenario was 45-year-old women with a BMD of 70% of YAM, GC dose of 10 mg per day, and previous fracture, and resulted in healthcare cost-savings. The worst-case scenario was 65-year-old women with a BMD of 80% of YAM, GC dose of 2.5 mg per day, and no previous fracture, and resulted in the ICER of $66,791 per QALY. Sensitivity analyses in the worst-case scenario showed that the annual discount rate for costs and health benefit had the strong influence on the estimated ICER. Although the ICER was influenced by other parameters such as disutility due to vertebral fracture, efficacy of alendronate, and so on, the ICERs remained more than $50,000 per QALY.
CONCLUSIONS: The cost-effectiveness of preventive alendronate therapy for postmenopausal women with osteopenia or osteoporosis using GC is sensitive to age, BMD, GC dose, and the presence of previous fracture. Our analysis suggested that the treatment indication for postmenopausal women with osteopenia or osteoporosis using GC in the current Japanese clinical
guidelines is likely to be cost-effective except for the limited patients who are at low risk for fracture.