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PharmacoEconomics

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01.12.2004 | Original Research Article

Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden

An economic evaluation based on the MORE study

verfasst von: Fredrik Borgström, Olof Johnell, John A. Kanis, Anders Oden, David Sykes, Bengt Jönsson

Erschienen in: PharmacoEconomics | Ausgabe 17/2004

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Abstract

Background: The Multiple Outcomes of Raloxifene Evaluation (MORE) study showed that treatment with raloxifene reduces the risk of vertebral fracture and breast cancer in postmenopausal women with osteoporosis.

Objective: Based on the MORE study the aim of the present study was to assess the cost effectiveness of raloxifene (compared with no treatment) for the treatment of osteoporosis in postmenopausal women in Sweden.

Design: A revised version of a previously developed computer simulation model was used. The impact of the risk-reducing effect of raloxifene on vertebral fractures and breast cancer on cost effectiveness was analysed using a clinical and a morphometric definition of vertebral fracture. Benefits of raloxifene treatment were measured in quality-adjusted life-years (QALYs) and life-years gained. The study estimated the cost effectiveness mainly from a healthcare perspective but the cost effectiveness taking a societal perspective was also analysed.

Results: Intervention costs (in Swedish kronor [SEK] and euros [€], year 2001 values) in postmenopausal women with a relative risk of vertebral fracture of 2 were SEK372 000 (€40 000), SEK303 000 (€33 000) and SEK263 000 (€28 000) per QALY for women aged 60, 70 and 80 years, at start of treatment, respectively, when the clinical vertebral definition was used. The cost effectiveness using a clinical morphometric vertebral fracture definition was similar to the cost effectiveness using a clinical vertebral fracture definition.

Conclusions: In relation to accepted threshold values for cost per QALY in Sweden, this model indicates, with its underlying assumptions and data, that raloxifene (compared with no treatment) is cost effective for the treatment of postmenopausal women at an increased risk of vertebral fracture, from the Swedish healthcare and societal perspectives.

National Osteoporosis Foundation. Osteoporosis: review of the evidence for prevention, diagnosis and treatment and costeffective analysis. Osteoporos Int 1998; 8 Suppl. 4: 1–88CrossRef

Kanis J, Johnell O, Oden A, et al. The risk and burden of vertebral fracture in Sweden. Osteoporos Int 2004 Jan; 15 (1): 20–6PubMedCrossRef

Cooper C, Campion G, Melton III LJ. Hip fractures in the elderly: a world-wide projection. Osteoporos Int 1992; 2 (6: 285–9PubMedCrossRef

Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999; 282 (7): 637–45PubMedCrossRef

Barrett-Connor E, Grady D, Sashegyi A, et al. Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple Outcomes of Raloxifene Evaluation) randomized trial. JAMA 2002; 287 (7): 847–57PubMedCrossRef

Johannesson M, Hedbrant J, Jonsson B. A computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention. Med Inform (Loud) 1991; 16 (4): 355–62CrossRef

Zethraeus N, Johannesson M, Jonsson B. A computer model to analyze the cost-effectiveness of hormone replacement therapy. Int J Technol Assess Health Care 1999; 15 (2): 352–65PubMed

Kanis JA, Dawson A, Oden A, et al. Cost-effectiveness of preventing hip fracture in the general female population. Osteoporos Int 2001; 12 (5): 356–61PubMedCrossRef

Kanis JA, Johnell O, Oden A, et al. Ten-year risk of osteoporotic fracture and the effect of risk factors on screening strategies. Bone 2002; 30 (1): 251–8PubMedCrossRef

10.

Kanis JA, Johnell O, Oden A, et al. Intervention thresholds for osteoporosis. Bone 2002; 31 (1): 26–31PubMedCrossRef

11.

Kanis JA, Johnell O, Oden A, et al. Risk of hip fracture derived from relative risks: an analysis applied to the population of Sweden. Osteoporos Int 2000; 11 (2): 120–7PubMedCrossRef

12.

Zethraeus N, Ben Sedrine W, Caulin F, et al. Models for assessing the cost-effectiveness of the treatment and prevention of osteoporosis. Osteoporos Int 2002; 13 (11): 841–57PubMedCrossRef

13.

Cauley JA, Norton L, Lippman ME, et al. Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial: multiple out comes of raloxifene evaluation. Breast Cancer Res Treat 2001; 65 (2): 125–34PubMedCrossRef

14.

Delmas PD, Ensrud KE, Adachi JD, et al. Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 2002; 87 (8): 3609–17PubMedCrossRef

15.

Michaelsson K, Baron JA, Farahmand BY, et al. Hormone replacement therapy and risk of hip fracture: population based case-control study. The Swedish Hip Fracture Study Group. BMJ 1998; 316 (7148): 1858–63PubMedCrossRef

16.

Stevenson JC, Kanis JA, Christiansen C. Bone-density measurement. Lancet 1992; 339 (8789): 370–1PubMedCrossRef

17.

Felson DT, Zhang Y, Hannan MT, et al. The effect of postmenopausal estrogen therapy on bone density in elderly women. N Engl J Med 1993; 329 (16: 1141–6PubMedCrossRef

18.

Tonino RP, Meunier PJ, Emkey R, et al. Skeletal benefits of alendronate: 7-year treatment of postmenopausal osteoporotic women. Phase III Osteoporosis Treatment Study Group. J Clin Endocrinol Metab 2000; 85 (9): 3109–15PubMedCrossRef

19.

Stock JL, Bell NH, Chesnut III CH, et al. Increments in bone mineral density of the lumbar spine and hip and suppression of bone turnover are maintained after discontinuation of alen dronate in postmenopausal women. Am J Med 1997; 103 (4): 291–7PubMedCrossRef

20.

Neele SJ, Evertz R, De Valk-De Roo G, et al. Effect of 1 year of discontinuation of raloxifene or estrogen therapy on bone mineral density after 5 years of treatment in healthy postmenopausal women. Bone 2002; 30 (4): 599–603PubMedCrossRef

21.

Kanis J, Brazier J, Stevenson M, et al. Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 2002; 6 (29): 1–146PubMed

22.

Nevitt MC, Ettinger B, Black DM, et al. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 1998; 128 (10): 793–800PubMed

23.

De Laet CE, van Hout BA, Burger H, et al. Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study. Osteoporos Int 1999; 10 (1): 66–72PubMedCrossRef

24.

Felsenberg D, Silman A, Lunt M, et al. Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 2002; 17 (4): 716–24PubMedCrossRef

25.

Kanis JA, Johnell O, Oden A, et al. Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 2000; 11 (8): 669–74PubMedCrossRef

26.

Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996; 312 (7041): 1254–9PubMedCrossRef

27.

Klotzbuecher CM, Ross PD, Landsman PB, et al. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 2000; 15 (4): 721–39PubMedCrossRef

28.

Cancer Incidence in Sweden 2000. Health and diseases. Stockholm: National Board of Health and Welfare, 2002

29.

Cauley JA, Lucas FL, Kuller LH, et al. Bone mineral density and risk of breast cancer in older women: the study of osteoporotic fractures. Study of Osteoporotic Fractures Research Group. JAMA 1996; 276 (17): 1404–8PubMedCrossRef

30.

Zhang Y, Kiel DP, Kreger BE, et al. Bone mass and the risk of breast cancer among postmenopausal women. N Engl J Med 1997; 336 (9): 611–7PubMedCrossRef

31.

Statistics Sweden 2001. Population statistics, part 4, Life Table 4.14 [online]. Available from http://www.scb.se [Accessed 2002 Aug 15]

32.

The Riksbank exchange rate statistics [online]. Available from http://www.riksbanken.se [Accessed 2002 Aug 17]

33.

The Swedish Pharmaceutical Benefits Board. Recommendation for economic evaluations. Stockholm: LFNAR 2003; 2003:2

34.

Zethraeus N, Borgström F, Johnell O, et al. Costs and quality of life associated with osteoporosis related fractures: results from a Swedish survey [online]. Working Paper Series in Economics and Finance, 512. Stockholm School of Economics, 2002 [online]. Available from URL: http://swopee.hhs.selhaste/abs/hastef0512.htm. [Accessed 2004 Nov 4]

35.

Jonsson B, Christiansen C, Johnell O, et al. Cost-effectiveness of fracture prevention in established osteoporosis. Scand J Rheumatol Suppl 1996; 103: 30–8PubMedCrossRef

36.

Zethraeus N, Molin T, Henriksson P, et al. Costs of coronary heart disease and stroke: the case of Sweden. J Intern Med 1999; 246 (2): 151–9PubMedCrossRef

37.

Liljegren G, Karlsson G, Bergh J, et al. The cost-effectiveness of routine postoperative radiotherapy after sector resection and axillary dissection for breast cancer stage I: results from a randomized trial. Ann Oncol 1997; 8 (8): 757–63PubMedCrossRef

38.

Meltzer D. Accounting for future costs in medical cost-effectiveness analysis. J Health Econ 1997; 16 (1): 33–64PubMedCrossRef

39.

Ekman M, Zethraeus N, Dahlstrom U, et al. Cost-effectiveness of bisoprolol in chronic heart failure [in Swedish]. Lakartidningen 2002; 99 (7): 646–50PubMed

40.

The Swedish drug compendium. Stockholm: Linfo Läkemedelsinformation AB, 2001

41.

Lundberg, L. Health-related quality of life in Sweden, in Faculty of Pharmacy. Uppsala: Uppsala University; 1999

42.

Oleksik A, Lips P, Dawson A, et al. Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 2000; 15 (7): 1384–92PubMedCrossRef

43.

Tosteson AN, Gabriel SE, Grove MR, et al. Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int 2001; 12 (12): 1042–9PubMedCrossRef

44.

Silverman SL, Minshall ME, Shen W, et al. The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the Multiple Outcomes of Raloxifene Evaluation Study. Arthritis Rheum 2001; 44 (11): 2611–9PubMedCrossRef

45.

Hall SE, Criddle RA, Comito TL, et al. A case-control study of quality of life and functional impairment in women with longstanding vertebral osteoporotic fracture. Osteoporos Int 1999; 9 (6: 508–15PubMedCrossRef

46.

Iglesias CP, Torgerson DJ, Bearne A, et al. The cost utility of bisphosphonate treatment in established osteoporosis. QJM 2002; 95 (5): 305–11PubMedCrossRef

47.

Gabriel SE, Kneeland TS, Melton III LJ, Health-related quality of life in economic evaluations for osteoporosis: whose values should we use? Med Decis Making 1999; 19 (2): 141–8PubMedCrossRef

48.

Brazier JE, Green C, Kanis JA. A systematic review of health state utility values for osteoporosis-related conditions. Osteoporos Int 2002; 13 (10): 768–76PubMedCrossRef

49.

Johnell O, Jonsson B, Jonsson L, et al. Cost effectiveness of alendronate (fosamax) for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics 2003; 21 (5): 305–14PubMedCrossRef

50.

Nevitt MC, Thompson DE, Black DM, et al. Effect of alendronate on limited-activity days and bed-disability days caused by back pain in postmenopausal women with existing vertebral fractures. Fracture Intervention Trial Research Group. Arch Intern Med 2000; 160 (1): 77–85PubMedCrossRef

51.

Johannesson M. The cost effectiveness of hypertension treatment in Sweden. Pharmacoeconomics 1995; 7 (3): 242–50PubMedCrossRef

52.

Cauley JA, Thompson DE, Ensrud KC, et al. Risk of mortality following clinical fractures. Osteoporos Int 2000; 11 (7): 556–61PubMedCrossRef

53.

Jalava T, Sama S, Pylkkanen L, et al. Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 2003; 18 (7): 1254–60PubMedCrossRef

54.

Center JR, Nguyen TV, Schneider D, et al. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 1999; 353 (9156: 878–82PubMedCrossRef

55.

Kanis JA, Odén A, Johnell O, et al. Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 2004; 15 (2): 108–12PubMedCrossRef

56.

Kanis J, Johnell O, Odén A, et al. Excess mortality after vertebral fracture. Sheffield: WHO Collabortaing Centre for Metabolic Bone Diseases, 2002

57.

Data extracted from the Swedish Cancer Register. Centre for Epidemiology at the Swedish National Board of Health and Welfare. Stockholm, 2002. (Data on file)

58.

Newhouse JP. US and UK health economics: two disciplines separated by a common language? Health Econ 1998; 7 Suppl. 1: S79–92PubMedCrossRef

59.

Raftery J. Analysis of guidance on health technologies. NICE: faster access to modern treatments? BMJ 2001; 323 (7324): 1300–3PubMedCrossRef

60.

Borgstrom F, Zethraeus N. Economic assessment based on a clinical study of risedronate: fracture prevention in elderly women with osteoporosis is cost-effective. Lakartidningen 2003; 100 (1-2): 36–40PubMed

61.

Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158 (6): 585–93PubMedCrossRef

62.

Burge R, Puleo E, Gehlbach S, et al. Inpatient hospital and postacute care for vertebral fractures in women. Value Health 2002; 5 (4): 301–11PubMedCrossRef

63.

Hallberg I, Rosenqvist AM, Kartous L, et al. Health-related quality of life after osteoporosis fractures. Osteoporosis Int 2004; 15 (10): 834–41CrossRef

Titel: Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden
An economic evaluation based on the MORE study
verfasst von: Fredrik Borgström
Olof Johnell
John A. Kanis
Anders Oden
David Sykes
Bengt Jönsson
Publikationsdatum: 01.12.2004
Verlag: Springer International Publishing
Erschienen in: PharmacoEconomics / Ausgabe 17/2004
Print ISSN: 1170-7690
Elektronische ISSN: 1179-2027
DOI: https://doi.org/10.2165/00019053-200422170-00005

Springer Medizin

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