TY  - JOUR
AU  - Chen, M
AU  - Si, L
AU  - Winzenberg, TM
AU  - Gu, J
AU  - Jiang, Q
AU  - Palmer, AJ
Y2  - 2020/12/21
Y1  - 2016
SN  - 1177-889X
UR  - http://hdl.handle.net/11343/257653
AB  - AIMS: Raloxifene treatment of osteoporotic fractures is clinically effective, but economic evidence in support of raloxifene reimbursement is lacking in the People's Republic of China. We aimed at evaluating the cost-effectiveness of raloxifene in the treatment of osteoporotic fractures using an osteoporosis health economic model. We also assessed the impact of medication persistence and adherence on clinical outcomes and cost-effectiveness of raloxifene. METHODS: We used a previously developed and validated osteoporosis state-transition microsimulation model to compare treatment with raloxifene with current practices of osteoporotic fracture treatment (conventional treatment) from the health care payer's perspective. A Monte Carlo probabilistic sensitivity analysis with microsimulations was conducted. The impact of medication persistence and adherence on clinical outcomes and the cost-effectiveness of raloxifene was addressed in sensitivity analyses. The simulated patients used in the model's initial state were 65-year-old postmenopausal Chinese women with osteoporosis (but without previous fractures), simulated using a 1-year cycle length until all patients had died. Costs were presented in 2015 US dollars (USD), and costs and effectiveness were discounted at 3% annually. The willingness-to-pay threshold was set at USD 20,000 per quality-adjusted life year (QALY) gained. RESULTS: Treatment with raloxifene improved clinical effectiveness by 0.006 QALY, with additional costs of USD 221 compared with conventional treatment. The incremental cost-effectiveness ratio was USD 36,891 per QALY gained. The cost-effectiveness decision did not change in most of the one-way sensitivity analyses. With full raloxifene persistence and adherence, average effectiveness improved compared with the real-world scenario, and the incremental cost-effectiveness ratio was USD 40,948 per QALY gained compared with conventional treatment. CONCLUSION: Given the willingness-to-pay threshold, raloxifene treatment was not cost-effective for treatment of osteoporotic fractures in postmenopausal Chinese women. Medication persistence and adherence had a great impact on clinical- and cost-effectiveness, and therefore should be incorporated in future pharmacoeconomic studies of osteoporosis interventions.
LA  - eng
PB  - Informa UK Limited
T1  - Cost-effectiveness of raloxifene in the treatment of osteoporosis in Chinese postmenopausal women: impact of medication persistence and adherence.
DO  - 10.2147/PPA.S100175
IS  - Patient Preference and Adherence
VL  - 10
SP  - 415-423
L1  - /bitstream/handle/11343/257653/PMC4820231.pdf?sequence=1&isAllowed=y
ER  -