The cost effectiveness of zoledronic acid 5 mg for the management of postmenopausal osteoporosis in women with prior fractures: evidence from Finland, Norway and the Netherlands

Abstract

Objective:

This study was conducted to assess the cost effectiveness of zoledronic acid 5 mg as a first-line treatment for the secondary prevention of fragility fractures in women with postmenopausal osteoporosis in Finland, Norway and the Netherlands.

Methods:

A discrete-event, individual-patient computer-simulation model was used to compare the cost effectiveness of zoledronic acid with that of basic treatment (calcium and vitamin D) and commonly prescribed bisphosphonates in postmenopausal women aged 50–80 years who have experienced one previous fracture and have a bone mineral density T-score of −2.5.

Results:

The cost per quality-adjusted life-year (QALY) gained with zoledronic acid compared with basic treatment ranged from being cost saving in all age groups in Norway, to costing approximately €19,000 in Finland and €22,300 in the Netherlands. Compared with the other branded bisphosphonates, zoledronic acid was cost saving in many scenarios, including all age groups in Finland. In Norway, zoledronic acid dominated branded risedronate and ibandronate in all age groups and dominated or had incremental cost-effectiveness ratios (ICERs) of up to NOK83,954 per QALY gained compared with branded alendronate. In the Netherlands, zoledronic acid dominated branded intravenous ibandronate in all age groups; compared with branded risedronate and oral ibandronate, zoledronic acid dominated or had ICERs of up to €4832 per QALY gained; compared with branded alendronate, it had ICERs of up to €48,383 per QALY gained. In all three countries, zoledronic acid may be cost effective compared with generic alendronate when patient compliance with drug therapy is taken into account. Sensitivity analyses showed that the model was robust to changes in key values. The main model limitations were the lack of real-life compliance and persistence data, and lack of country-specific data for some parameters.

Conclusions:

Using local or commonly used thresholds, this analysis suggests that zoledronic acid would be a cost-effective first-line option compared with other branded bisphosphonates and, in some scenarios, compared with generic alendronate, for the secondary prevention of fractures in women with postmenopausal osteoporosis in Finland, Norway and the Netherlands.

Key words::

• Zoledronic acid 5 mg
• Bisphosphonates
• Cost effectiveness
• Postmenopausal osteoporosis

Transparency

Declaration of funding

This work was supported by an unrestricted educational grant from Novartis Pharmaceutical Corporation.

Declaration of financial/other relationships

R. Akehurst received payment from Novartis for the original model development to support reimbursement submissions relating to zoledronic acid but did not receive fees or funding in relation to the development of the current manuscript; he is also a paid adviser to Novartis on other products.

R. Ariely is an employee of Novartis Pharmaceuticals Corporation.

S.B. has received consultancy fees and research funding from Novartis but did not receive fees or funding in relation to the development of the current manuscript.

N.B. has received consultancy fees from Novartis but did not receive fees or funding in relation to the development of the current manuscript.

P.F. is an employee of Novartis Norge AS.

M.G. is an employee of Novartis Pharma BV.

T.L. is an employee of Novartis Finland Oy.

Acknowledgements

Editorial support was provided by J. Ponting at Anthemis Consulting Ltd, funded by Novartis Pharmaceutical Corporation.

Notes

* This was the rate applicable at the time of the analysis. The most recent guidance (2009) recommends a rate of 3.0%⁴⁵.