title: What are we paying for? A cost-effectiveness analysis of patented denosumab and generic alendronate for postmenopausal osteoporotic women in Australia.
abstract: OBJECTIVE
  Zoledronic acid and denosumab were funded by the Australian government for the management of osteoporosis at an equivalent price to alendronate. The price of alendronate has declined by around 65 %, but the price of the other two therapies has remained stable. Using data published since the listing, this paper reports current estimates of the value of denosumab compared to alendronate from an Australian health system perspective.
  
  
  METHODS
  A cohort-based state transition model was developed that predicted changes in bone mineral density (BMD), and calibrated fracture probabilities as a function of BMD, age and previous fracture to estimate differences in costs and QALYs gained over a 10-year time horizon.
  
  
  RESULTS
  The base-case incremental cost per QALY gained for denosumab versus alendronate was $246,749. There is a near zero probability that denosumab is cost-effective at a threshold value of $100,000 per QALY gained. If the price of denosumab was reduced by 50 %, the incremental cost per QALY gained falls to $50,068.
  
  
  CONCLUSIONS
  Current Australian legislation precludes price reviews when comparator therapies come off patent. The presented analysis illustrates a review process, incorporating clinical data collected since the original submission to inform a price at which denosumab would provide value for money.
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA 5005 Australia.
authors.forename: Jonathan
authors.identifier: 0000-0003-3220-2099
authors.initials: J
authors.lastname: Karnon
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA 5005 Australia.
authors.forename: Ainul Shakirah
authors.initials: AS
authors.lastname: Shafie
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA 5005 Australia.
authors.forename: Nneka
authors.initials: N
authors.lastname: Orji
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, SA 5005 Australia.
authors.forename: Sofoora Kawsar
authors.initials: SK
authors.lastname: Usman
keywords: Calibration; Cost-effectiveness; Generic; Osteoporosis; Patent; Pharmaceutical pricing