Economic Evaluation of Oral Alendronate Therapy for Osteoporosis in
Chinese Postmenopausal Women: The Impact of Medication Compliance and
Persistence
Abstract
Aims: The purpose of the present research was to evaluate the
cost-effectiveness of oral alendronate for individuals with
osteoporosis. We also assessed the impact of medication compliance and
persistence on economic outcomes of alendronate, and potential economic
evaluations of persistence-enhancing interventions. Methods: We
constructed an individual-level state-transition model to project health
outcomes and costs of oral alendronate for Chinese postmenopausal
osteoporotic women. The impact of medication compliance and persistence
on economic evaluation was addressed in various scenario analyses. Model
inputs were derived from clinical trials and published sources where
available. Deterministic and probabilistic sensitivity analyses were
conducted to explore the impact of uncertainties and assumptions on the
cost-effectiveness results. Results: Compared to no treatment,
alendronate treatment was associated with an additional 0.052 QALYs at
an additional cost of USD 738, which yielded an ICER of USD
14,192.308/QALY. The ICER for the different scenarios (full compliance,
full persistence, both full persistence and full compliance) were USD
4933.333/QALY, USD 3006.84/QALY and USD 2019.822/QALY, respectively.
One-way sensitivity analysis showed the ICER was most sensitive to
variations in time horizon and residual effect. Probabilistic
sensitivity analysis demonstrated that, at a willingness-to-pay of USD
29,340/QALY, the probability that oral alendronate therapy will be
cost-effective is approximate 80%. Conclusions: The findings support
the view that oral alendronate is cost-effective for the treatment of
osteoporotic fractures in Chinese postmenopausal women. Medication
persistence is found to have a greater impact on cost-effectiveness than
compliance, and interventions to improve persistence to be an efficient
use of resources.