Cost-effectiveness of bazedoxifene incorporating the FRAX® algorithm in a European perspective.
The cost-effectiveness of bazedoxifene was compared to placebo in France, Germany, Italy, Spain, Sweden and the UK from a healthcare perspective using FRAX® for both fracture risks and for treatment efficacy. Cost/QALY differences were explained to a large extent by differences in fracture risk.


BACKGROUND
In cost-effectiveness modelling of osteoporosis treatments, the fracture risk has traditionally been calculated with risk adjustments based on age, bone mineral density and prior fracture. However, knowledge of additional clinical risk factors contributes to fracture risk assessment as demonstrated by the FRAX® tool. Bazedoxifene, a new selective estrogen receptor modulator for the treatment and prevention of osteoporosis, has been shown in a phase III clinical trial to reduce the risk of osteoporotic fractures in women. In an analysis using FRAX®, the efficacy of bazedoxifene was greater in patients with higher fracture risk.


METHODS
The aim of this study was to evaluate the cost-effectiveness of bazedoxifene compared to placebo in France, Germany, Italy, Spain, Sweden and the UK from a healthcare perspective using FRAX®. A Markov cohort model was adapted to incorporate the FRAX® risk factors. FRAX® produces relative risks for hip fractures and major osteoporotic fractures. Patients were given a 5-year intervention, reducing the risk of fractures in a risk-dependent manner. The effect of treatment on fractures was assumed to decline linearly over 5 years after the intervention.


RESULTS
There are large cost/quality-adjusted life year variations between countries in the European setting studied. The base case values ranged from cost saving (Sweden) to EUR 105,450 (Spain) in 70-year-old women with a T-score of -2.5 SD and a prior fracture.


CONCLUSIONS
Bazedoxifene can be a cost-effective treatment for postmenopausal osteoporosis. The variability between countries was explained to a large extent by differences in fracture risk, and the estimated cost-effectiveness was highly dependent on the population's FRAX®-estimated probability of major osteoporotic fracture.
Borgström
F
F
i3 Innovus, Stockholm, Sweden. fredrik.borgstrom@i3innovus.com
Ström
O
O
Kleman
M
M
McCloskey
E
E
Johansson
H
H
Odén
A
A
Kanis
J A
JA
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003362:Cost-Benefit Analysis; D005060:Europe / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007211:Indoles / Q000191:economics* / Q000627:therapeutic use; D008390:Markov Chains; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000191:economics*; D058866:Osteoporotic Fractures / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment / Q000191:economics* / Q000379:methods; D020845:Selective Estrogen Receptor Modulators / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome
D007211:Indoles; D020845:Selective Estrogen Receptor Modulators; C447119:bazedoxifene