Cost-effectiveness of bazedoxifene versus raloxifene in the treatment of postmenopausal women in Spain

Figures & data

Figure 1 Graphic representation of the model.

Table 1 Transition probabilities for bazedoxifene 20 mg/day and raloxifene 60 mg/day

Bazedoxifene	Well	Vertebral fracture	Nonvertebral fracture	Healthy nonvertebral fracture	Healthy nonvertebral fracture	Dead
Well	0.94479a	0.00901b,c	0.024b,d	0	0	0.022e
Vertebral fracture	0	0	0	0.9768120a	0	0.023188e
Nonvertebral fracture	0	0	0.1384667b,f	0	0.8351333a	0.0264g
Healthy vertebral fracture	0	0.0275706b,h	0.1986292b,i	0.7506122a	0	0.023188j
Healthy nonvertebral fracture	0	0.0103615b	0.0528313h	0	0.9126072a	0.0242k
Dead	0	0	0	0	0	1
Raloxifene	Well
Well	0.944994a	0.008806b,c	0.024b,d	0	0	0.022e
Vertebral fracture	0	0	0	0.9768120a	0	0.023188e
Nonvertebral fracture	0	0	0.1897467b,f	0	0.7838533a	0.0264g
Healthy vertebral fracture	0	0.0271577b,h	0.2287228b,i	0.7209315a	0	0.023188j
Healthy nonvertebral fracture	0	0.0100682b	0.0608356h	0	0.90489624a	0.0242k
Dead	0	0	0	0	0	1

Notes:

a Residual probability

b Silverman et al¹⁴

c Felsenberg et al²³

d Marin et al²⁴

e Ministerio de Sanidad, Política Social e Igualdad (MSPI)²⁵

f Christodoulou and Cooper⁴⁵

g Sociedad Navarra de Medicina de Familia y Atención Primaria. Documento para el Manejo de la Osteoporosis en Atención Primaria (SNAMFAP)²⁷

h Sociedad Española de Investigaciones Óseas y Metabolismo Mineral (SEIOMM)⁷

i Naves et al⁴⁶

j Agència d′Informació, Avaluació i Qualitat en Salut. (AIAQS)²⁶

k Borgstrom et al³³. All probabilities without notes are based on assumption.

Table 2 Utilities

Health condition	Utilitya	Corrected utility for adverse events
		Bazedoxifeneb	Raloxifeneb
Well	1	0.996	0.9954
Vertebral fracture	0.620	0.61752	0.617148
Nonvertebral fracture	0.651	0.647898	0.6475077
Healthy post vertebral fracture	0.910	0.90636	0.905814
Healthy post nonvertebral fracture	0.940	0.9358416	0.93527784
QoL loss due to eachadverse event of 10%c,d,*	−0.1	–	–

Notes:

* Includes assumption

a Adachi et al²⁸

b Silverman et al¹⁴

c Sobocki et al²⁹

d Zethraeus et al³⁰.

Abbreviation: QoL, quality of life.

Table 3 Osteoporosis treatment and fractures: resource utilization in units and costs

	Units	Cost (EUR) 2010
Treatment
Drug costs		287a
Conventional blood test	1	21b
Bone density scan	1	165c
Visit to rheumatologist	1.5	69d
Annual treatment costs		576
Vertebral fracture
Hospitalization vertebral fracture (average 2 days)		3,513.90e
Radiography	1	32.80f
Bone scan	1	232.34g
Visit to orthopedic surgeon	2	44.10d
Analgesics (2 tablets/day, 90 days)		0.06a
Annual treatment costs		3878
Nonvertebral fracture
Hip fracture
Hospitalization hip fracture (average 15 days)		7,956.70e
Visits to orthopedic surgeon	3	44.10d
Radiography	2	32.80f
Rehabilitation (40 days)		52.87b
Analgesics (2 tablets/day, 90 days)		0.06a
Wrist fracture
Surgery	1	96.97h
Hospitalization wrist fracture (average of 4 days)	4	555.71d
Visits to orthopedic surgeon	3	44.10d
Radiography	3	32.80f
Rehabilitation (40 days)		52.87b
Analgesics (2 tablets/day, during 90 days)		0.06a
Annual treatment costs (50% hipand 50% wrist)		7478

Notes:

a Vademecum³²

b Hospital Lluís Alcanyis⁴⁷

c Hospital de la Esperanza⁴⁸

d Instituto Nacional de la Salud (INSALUD)⁴⁹

e Finnern and Sykes⁵⁰

f Cernuda⁵¹

g Diari Oficial de la Generalitat de Catalunya (DOGC)⁵²

h DOGC⁵³.

Table 4 Adverse events: resource utilization in units and costs

Adverse events	Units	Cost (€) 2010
Leg cramps
Basic analyses: blood, biochemistry, electrolytes	1	39a
Visit to specialist physician	1	46b
Annual treatment costs		85
Deep vein thrombosis
Basic analyses: blood, biochemistry, ions	1	39a
Doppler echocardiogram	1	70b
Plethysmography of legs	1	111b
Venography	1	79b
Visit to specialist physician	1	46b
Heparin sodium (injection 5000 UI/mL, 5 days)		1.83c
Warfarin (5 mg/day, 40 days)		2.30c
Annual treatment costs		349
Breast cysts/fibrocystic breast disease
Mammography	1	128b
Visit to specialist physician	1	46b
Annual treatment costs		174

Notes:

a Diari Oficial de la Generalitat de Catalunya (DOGC)⁵³

b Boletín Oficial De La Rioja (BOR)⁵⁴

c Vademecum³².

Table 5 Annual cost per health state

Health state	Cost (€) 2010	Corrected costs events for adverse
		Bazedoxifene	Raloxifene
Well	576	580	581
Vertebral fracture	3878	4458	4459
Nonvertebral fracture	7478	8058	8059
Healthy post vertebral fracture	576	580	581
Healthy post nonvertebral fracture	576	580	581

Table 6 Total cost, incremental costs, QALY, QALYs gained, and ICER

Treatment	Cost (€)	Incremental costs	QALY	QALYs gained	ICER (€/QALY)
Bazedoxifene	13,436	−444 €	14.56	+0.02	Dominant
Raloxifene	13,881		14.54

Abbreviations: QALY, quality-adjusted life-years; ICER, incremental cost-effectiveness ratio.

Figure 2 Cost-effectiveness acceptability curves: bazedoxifene versus raloxifene.

Figure 3 Cost-effectiveness of bazedoxifene versus raloxifene in postmenopausal women with osteoporosis.

Abbreviation: QALY, quality-adjusted life-years.

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