Cost-Effectiveness of Denosumab for Post-Menopausal Osteoporosis in South Korea

ABSTRACT

BACKGROUND: In South Korea, 22.3% of women ≥50 years of age and 37% of women ≥70 years of age visit the doctor to obtain treatment for osteoporosis. According to the analysis of the National Health Insurance Services claim data between 2008 and 2012, the number and incidence of hip and vertebral fractures increased during the same period. Denosumab, a newly marketed medicine in Korea, is the first RANK inhibitor. METHODS: A cost-utility analysis was conducted from a societal perspective to prove the superiority of denosumab to alendronate. A Markov cohort model was used to investigate the cost-effectiveness of denosumab. A 6-month cycle length was used in the model, and all patients were individually followed up through the model, from their age at treatment initiation to their time of death or until 100 years of age. The model consisted of eight health states well; hip fracture; vertebral fracture; wrist fracture; other osteoporotic fracture; post-hip fracture; post-vertebral fracture; and dead. All patients began in the well-health state. In this model, 5% discounted rate, two-year maximum offset time, and persistence were adopted. RESULTS: The total lifetime costs for alendronate and denosumab were USD 5,587 and USD 6,534, respectively. The incremental costeffectiveness ratio (ICER) for denosumab versus alendronate was USD 20,600/QALY. Given the ICER threshold in Korea, the results indicated that denosumab was remarkably superior to alendronate. CONCLUSION: Denosumab is a cost-effective alternative to the oral anti-osteoporotic treatment, alendronate, in South Korea.