Cost effectiveness of teriparatide and PTH(1-84) in the treatment of postmenopausal osteoporosis.
OBJECTIVE
The purpose was to assess the cost effectiveness from a societal perspective of the recombinant human parathyroid hormones: PTH(1-34) (teriparatide) and PTH(1-84) for patients with osteoporosis with similar characteristics to patients treated in normal clinical practice in Sweden.


METHODS
A Markov model of osteoporosis in postmenopausal women was developed using 6-month cycles and a lifetime horizon. The model was populated with patients similar to the Swedish cohort of the European Forsteo Observational Study (postmenopausal women; mean age: 70 years, total hip T-score: -2.7 and 3.3 previous fractures). The cost effectiveness of both teriparatide and PTH(1-84) was estimated compared to no treatment and each other. Relative effectiveness assumptions were based on efficacy estimates from two phase III clinical trials.


RESULTS
The cost per QALY gained of teriparatide vs. no treatment was estimated at €43,473 and PTH(1-84) was estimated at €104,396. Teriparatide was indicated to be less costly and associated with more life-years and QALYs than PTH(1-84). When assuming no treatment effect on hip fractures the cost per QALY gained was €88,379. In the sensitivity analysis the cost effectiveness did not alter substantially with changes in the majority of the model parameters except for the residual effect of the treatment after stopping therapy.


CONCLUSIONS
Based on the efficacy estimates from pivotal clinical trials and characteristics of patients treated in clinical practice in Sweden, teriparatide seems to be a more cost-effective option than PTH(1-84) when compared to no treatment. The relative efficacy between the two PTH compounds was based on an indirect comparison from two separate clinical trials which has to be considered when interpreting the results.
Borgström
Fredrik
F
i3 Innovus, Stockholm, Sweden, and LIME/MMC, Karolinska Institute, Stockholm, Sweden. fredrik.b@healtheconomics.se
Ström
Oskar
O
Marin
Fernando
F
Kutahov
Alexey
A
Ljunggren
Osten
O
D000368:Aged; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000209:etiology; D006801:Humans; D008390:Markov Chains; D015337:Multicenter Studies as Topic; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D010281:Parathyroid Hormone / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D013548:Sweden; D019379:Teriparatide / Q000191:economics* / Q000627:therapeutic use*
D050071:Bone Density Conservation Agents; D010281:Parathyroid Hormone; D019379:Teriparatide