Cost-effectiveness of raloxifene in the treatment of osteoporosis in Chinese postmenopausal women: impact of medication persistence and adherence.
OBJECTIVE
Raloxifene treatment of osteoporotic fractures is clinically effective, but economic evidence in support of raloxifene reimbursement is lacking in the People's Republic of China. We aimed at evaluating the cost-effectiveness of raloxifene in the treatment of osteoporotic fractures using an osteoporosis health economic model. We also assessed the impact of medication persistence and adherence on clinical outcomes and cost-effectiveness of raloxifene.


METHODS
We used a previously developed and validated osteoporosis state-transition microsimulation model to compare treatment with raloxifene with current practices of osteoporotic fracture treatment (conventional treatment) from the health care payer's perspective. A Monte Carlo probabilistic sensitivity analysis with microsimulations was conducted. The impact of medication persistence and adherence on clinical outcomes and the cost-effectiveness of raloxifene was addressed in sensitivity analyses. The simulated patients used in the model's initial state were 65-year-old postmenopausal Chinese women with osteoporosis (but without previous fractures), simulated using a 1-year cycle length until all patients had died. Costs were presented in 2015 US dollars (USD), and costs and effectiveness were discounted at 3% annually. The willingness-to-pay threshold was set at USD 20,000 per quality-adjusted life year (QALY) gained.


RESULTS
Treatment with raloxifene improved clinical effectiveness by 0.006 QALY, with additional costs of USD 221 compared with conventional treatment. The incremental cost-effectiveness ratio was USD 36,891 per QALY gained. The cost-effectiveness decision did not change in most of the one-way sensitivity analyses. With full raloxifene persistence and adherence, average effectiveness improved compared with the real-world scenario, and the incremental cost-effectiveness ratio was USD 40,948 per QALY gained compared with conventional treatment.


CONCLUSIONS
Given the willingness-to-pay threshold, raloxifene treatment was not cost-effective for treatment of osteoporotic fractures in postmenopausal Chinese women. Medication persistence and adherence had a great impact on clinical- and cost-effectiveness, and therefore should be incorporated in future pharmacoeconomic studies of osteoporosis interventions.
School of Health Policy & Management, Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China.
Mingsheng
M
Chen
Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; School of Health Administration, Anhui Medical University, Hefei, Anhui, People's Republic of China.
Lei
L
Si
Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; School of Medicine, University of Tasmania, Hobart, TAS, Australia.
Tania M
TM
Winzenberg
Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.
Jieruo
J
Gu
School of Health Administration, Anhui Medical University, Hefei, Anhui, People's Republic of China.
Qicheng
Q
Jiang
Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
Andrew J
AJ
Palmer
Chinese; adherence; cost-effectiveness; persistence; postmenopausal osteoporosis