Impact of treatment efficacy and dosing frequency on cost-effectiveness of bisphosphonate treatment for osteoporosis: a perspective

Abstract

Background:

Osteoporosis is a chronic disease that presents a large economic burden both on the affected individual and on society. Osteoporotic fractures are a cause of significant morbidity and mortality. Given the high prevalence of osteoporosis and related costs, understanding the factors that determine the cost-effectiveness of osteoporosis therapy is important for physicians and managed-care organizations. Bisphosphonates are considered first-line therapy for osteoporosis, and pharmacological differences between them relate not only to differences in efficacy and safety, but also have an impact on health economics. Efficacy and persistence with therapy influence fracture risk-reduction and should be considered when determining the best osteoporosis therapy for each patient.

Scope:

This article synthesizes recent health economic data, assessing the impact of drug efficacy and persistence or dosing frequency on the cost-effectiveness of bisphosphonates as therapeutic agents for osteoporosis treatment. The author's interpretation of the available evidence is also discussed, from the perspective of a ‘Commentary’ article.

Findings:

Although treatment persistence is an important factor in reducing fracture risk, when comparing the health economic data of several treatment options, studies have shown that the cost-effectiveness of bisphosphonate therapy is mainly dependent on drug efficacy rather than persistence or dosing frequency. It should also be noted that fractures at different skeletal sites have different economic impacts. Non-vertebral fractures (and particularly those of the hip) are more costly than vertebral fractures.

Conclusions:

Although persistence with osteoporosis therapy is an important factor in reducing fracture risk, it has less of an impact on cost-effectiveness than treatment efficacy, in particular efficacy at non-vertebral sites.

Key words: :

• Bisphosphonates
• Cost-effectiveness
• Efficacy
• Persistence
• Postmenopausal osteoporosis

Transparency

Declaration of funding

The author received editorial/writing support in the preparation of this article, with funding provided by The Alliance for Better Bone Health (Procter & Gamble Pharmaceuticals and sanofi-aventis US, Inc.). The author was fully responsible for all content and editorial decisions and received no form of compensation related to the development of the manuscript.

Declaration of financial/other relationships

S.B. has disclosed that he has received research funding from GlaxoSmithKline, Merck, Novartis, Procter & Gamble Pharmaceuticals, Roche and sanofi-aventis; that he has received consulting fees from Merck, Novartis, Procter & Gamble Pharmaceuticals and sanofi-aventis; and that he has received lecture fees from Novartis, Procter & Gamble Pharmaceuticals and sanofi-aventis.

Peer reviewers receive honoraria from CMRO for their review work. Peer Reviewer 1 and Peer Reviewer 2 have disclosed that they have no relevant financial relationships.

Acknowledgment

Sandra Mendes, PhD, from Excerpta Medica provided editorial/writing assistance (with funding provided by The Alliance for Better Bone Health).