title: Cost-effectiveness analysis of once-yearly injection of zoledronic acid for the treatment of osteoporosis in Japan.
abstract: Model-based economic evaluation was performed to assess the cost-effectiveness of zoledronic acid. Although zoledronic acid was dominated by alendronate, the incremental quality-adjusted life year (QALY) was quite small in extent. Considering the advantage of once-yearly injection of zoledronic acid in persistence, zoledronic acid might be a cost-effective treatment option compared to once-weekly oral alendronate.
  
  
  
  The purpose of this study was to estimate the cost-effectiveness of once-yearly injection of zoledronic acid for the treatment of osteoporosis in Japan.
  
  
  
  A patient-level state-transition model was developed to predict the outcome of patients with osteoporosis who have experienced a previous vertebral fracture. The efficacy of zoledronic acid was derived from a published network meta-analysis. Lifetime cost and QALYs were estimated for patients who had received zoledronic acid, alendronate, or basic treatment alone. The incremental cost-effectiveness ratio (ICER) of zoledronic acid was estimated.
  
  
  
  For patients 70 years of age, zoledronic acid was dominated by alendronate with incremental QALY of -0.004 to -0.000 and incremental cost of 430 USD to 493 USD. Deterministic sensitivity analysis indicated that the relative risk of hip fracture and drug cost strongly affected the cost-effectiveness of zoledronic acid compared to alendronate. Scenario analysis considering treatment persistence showed that the ICER of zoledronic acid compared to alendronate was estimated to be 47,435 USD, 27,018 USD, and 10,749 USD per QALY gained for patients with a T-score of -2.0, -2.5, or -3.0, respectively.
  
  
  
  Although zoledronic acid is dominated by alendronate, the incremental QALY is quite small in extent. Considering the advantage of annual zoledronic acid treatment in compliance and persistence, zoledronic acid may be a cost-effective treatment option compared to alendronate.
authors.affiliation: Department of Medical Statistics, Kobe Pharmaceutical University, 4-19-1, Motoyamakita, Higashinada, Kobe, 658-8558, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Moriwaki
authors.affiliation: Global Health Research Coordinating Center, Kanagawa Academy of Science and Technology, KSP East 3F 309, 3-2-1, Sakado, Takatsu, Kawasaki, Kanagawa, Japan.|Project Research Institutes, Comprehensive Research Organization, Waseda University, Tokyo, 169-8050, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Mouri
authors.affiliation: School of Health Sciences, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori, 683-8503, Japan. hagino@med.tottori-u.ac.jp.
authors.forename: H
authors.initials: H
authors.lastname: Hagino
mesh_terms: D000368:Aged; D019386:Alendronate / Q000191:economics / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004164:Diphosphonates / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000191:economics / Q000517:prevention & control; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D007275:Injections, Intravenous; D007564:Japan; D017059:Models, Econometric; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000191:economics; D058866:Osteoporotic Fractures / Q000191:economics / Q000517:prevention & control; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000191:economics / Q000517:prevention & control; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D019386:Alendronate
keywords: Cost-effectiveness analysis; Fracture prevention; Health economics; Osteoporosis; Zoledronic acid