Patient Preference and Adherence (Mar 2016)
Cost-effectiveness of raloxifene in the treatment of osteoporosis in Chinese postmenopausal women: impact of medication persistence and adherence
Abstract
Mingsheng Chen,1 Lei Si,2,3 Tania M Winzenberg,2,4 Jieruo Gu,5 Qicheng Jiang,3 Andrew J Palmer2 1School of Health Policy & Management, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China; 2Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; 3School of Health Administration, Anhui Medical University, Hefei, Anhui, People’s Republic of China; 4School of Medicine, University of Tasmania, Hobart, TAS, Australia; 5Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China 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. Keywords: cost-effectiveness, postmenopausal osteoporosis, Chinese, persistence, adherence
