Cost-utility analysis of denosumab and teriparatide in the treatment of postmenopausal osteoporosis in Chinese women

DU Guiping; LI Yukun; LI Min; XUE Peng; LIU Yan; LIU Guoqiang

doi:10.6039/j.issn.1001-0408.2023.02.09

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Cost-utility analysis of denosumab and teriparatide in the treatment of postmenopausal osteoporosis in Chinese women

更新时间：2025-09-25

- Cost-utility analysis of denosumab and teriparatide in the treatment of postmenopausal osteoporosis in Chinese women
- ZHONGGUO YAOFANG Vol. 34, Issue 2, Pages: 173-178(2023)
- 作者机构：
  
  1.河北医科大学第三医院临床药学部，石家庄　050051
  2.河北医科大学第三医院内分泌二科，石家庄　050051
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.02.09
  CLC： R956
- Received：16 August 2022，
  
  Revised：2023-01-02，
  
  Published：30 January 2023
- 稿件说明：
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杜桂平,李玉坤,李敏,等.地舒单抗和特立帕肽治疗中国女性绝经后骨质疏松症的成本-效用分析[J].中国药房,2023,34(02):173-178.

DU Guiping,LI Yukun,LI Min,et al.Cost-utility analysis of denosumab and teriparatide in the treatment of postmenopausal osteoporosis in Chinese women[J].ZHONGGUO YAOFANG,2023,34(02):173-178.
杜桂平,李玉坤,李敏,等.地舒单抗和特立帕肽治疗中国女性绝经后骨质疏松症的成本-效用分析[J].中国药房,2023,34(02):173-178. DOI： 10.6039/j.issn.1001-0408.2023.02.09.

DU Guiping,LI Yukun,LI Min,et al.Cost-utility analysis of denosumab and teriparatide in the treatment of postmenopausal osteoporosis in Chinese women[J].ZHONGGUO YAOFANG,2023,34(02):173-178. DOI： 10.6039/j.issn.1001-0408.2023.02.09.

摘要

目的

评价地舒单抗和特立帕肽治疗中国女性绝经后骨质疏松症的经济性，为相关决策提供参考。

方法

从我国医疗卫生体系角度出发，利用Excel 2003软件建立马尔科夫模型，采用成本-效用分析法评价地舒单抗和特立帕肽分别联合碳酸钙D

片治疗中国女性绝经后骨质疏松症的经济性。药物治疗效果来自网状荟萃结果，成本和健康效用值数据来自已发表的文献。模型的循环周期为1年，模拟时限为患者终身。采用单因素敏感性分析和概率敏感性分析评价模型参数变化对结果稳健性的影响；并通过情境分析探讨特立帕肽组采用国产药的药品成本的经济性，特立帕肽组药物后遗效应对结果的影响以及特立帕肽停药后序贯使用地舒单抗治疗的经济性。

结果

地舒单抗方案的效果优于特立帕肽方案[13.24 质量调整生命年（QALYs）vs.12.96 QALYs]，同时其成本也更低（51 224.64元vs.167 102.67元），地舒单抗方案为绝对优势方案。单因素敏感性分析结果显示，特立帕肽注射液的成本和贴现率对结果的影响较大。概率敏感性分析结果显示，使用3倍我国2021年人均国内生产总值作为意愿支付阈值时，地舒单抗方案具有经济性的概率为93.5%。情境分析结果显示，无论特立帕肽方案换用国产药的药品成本，还是考虑特立帕肽的药物后遗效应，又或是特立帕肽用药2年后序贯使用地舒单抗治疗，地舒单抗方案都是绝对优势方案。

结论

地舒单抗联合碳酸钙D

片治疗中国女性绝经后骨质疏松症较特立帕肽联合碳酸钙D

片更具经济性。

Abstract

OBJECTIVE

To evaluate the cost-effectiveness of denosumab and teriparatide in the treatment of postmenopausal osteoporosis in Chinese women， and provide reference for relevant decision-making.

METHODS

From the perspective of health system in China， Excel 2003 was used to establish Markov model， and cost-utility analysis was used to evaluate the cost-effectiveness of denosumab or teriparatide combined with Calcium carbonate D

tablets in the treatment of postmenopausal osteoporosis in Chinese women. Pharmacotherapy effects were obtained with network meta-analysis， and cost and health utility value data were obtained from published literature. The model cycle was 1 year， and the simulation time limit was the patient’s lifetime. Univariate sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the effects of model parameter changes on the robustness of the results. Through scenario analysis， the cost-effectiveness of domestic drug cost used as drug cost of terlipatide group was discussed； the influence of residual effects of teriparatide on the results and the cost-effectiveness of sequential use of desumamab after terlipatide withdrawal were also discussed.

RESULTS

The effect of denosumab regimen was better than that of terlipatide regimen [13.24 quality-adjusted life years （QALYs） vs. 12.96 QALYs]， with lower cost （51 224.64 yuan vs. 167 102.67 yuan）， denosumab regimen was the absolutely superior regimen. The results of single factor sensitivity analysis showed that the cost and discount rate of Terlipatide injection had greater impact on the results. The results of probability sensitivity analysis showed that when three times of China’s per capita gross domestic product （GDP） in 2021 was used as the threshold of willingness to pay， the probability of cost-effectiveness of denosumab regimen was 93.5%. The results of scenario analysis showed that， whether the drug cost of terlipatide regimen which was replaced by domestic drugs， or the residual effect of terlipatide was considered， or desulmonab was used sequentially after two years of terlipide treatment， denosumab regimen was always the absolute advantage regimen.

CONCLUSIONS

Denosumab combined with Calcium carbonate D

tablets is more cost-effective than teriparatide combined with Calcium carbonate D

tablets in the treatment of postmenopausal osteoporosis in Chinese women.

关键词

Keywords

references

中华医学会骨质疏松和骨矿盐疾病分会 . 原发性骨质疏松症诊疗指南：2017 [J ] . 中国实用内科杂志， 2018 ， 38 （ 2 ）： 127 - 150 .

智信，陈晓，苏佳灿 . 绝经后骨质疏松症发病机制研究进展 [J ] . 中国骨质疏松杂志， 2018 ， 24 （ 11 ）： 1510 - 1513，1534 .

邓睿华，许小明，钟际香，等 . 绝经后骨质疏松妇女运动管理的最佳证据总结 [J ] . 护理研究， 2022 ， 36 （ 4 ）： 640 - 644 .

SHOBACK D ， ROSEN C J ， BLACK D M ， et al . Pharmacological management of osteoporosis in postmenopausal women：an endocrine society guideline update [J ] . J Clin Endocrinol Metab ， 2020 ， 105 （ 3 ）： dgaa048 .

夏维波 . 地舒单抗在骨质疏松症临床合理用药的中国专家建议 [J ] . 中华骨质疏松和骨矿盐疾病杂志， 2020 ， 13 （ 6 ）： 499 - 508 .

郑蹦蹦，王佳明，余迎奇，等 . 绝经后骨质疏松症的药物防治研究进展 [J ] . 医学综述， 2021 ， 27 （ 18 ）： 3675 - 3681 .

翟晓，杨新明，刘芳宏，等 . 特立帕肽联合利塞膦酸钠治疗骨质疏松椎体压缩骨折患者的骨代谢 [J ] . 中国组织工程研究， 2022 ， 26 （ 35 ）： 5685 - 5692 .

国家统计局 . 数据统计 [EB/OL ] .[ 2022-02-11 ] . http：//www.stats.gov.cn/tjsj/ http://www.stats.gov.cn/tjsj/ .

SI L ， WINZENBERG T M ， JIANG Q ， et al . Projection of osteoporosis-related fractures and costs in China：2010-2050 [J ] . Osteoporos Int ， 2015 ， 26 （ 7 ）： 1929 - 1937 .

于龙，王亮 . 老年骨质疏松症现状及进展 [J ] . 中国临床保健杂志， 2022 ， 25 （ 1 ）： 6 - 11 .

YOU R X ， ZHANG Y ， WU D B C ， et al . Cost-effectiveness of zoledronic acid versus oral alendronate for postmenopausal osteoporotic women in China [J ] . Front Pharmacol ， 2020 ， 11 ： 456 .

李梅，夏维波，章振林 . 骨转换生化标志物临床应用指南 [J ] . 中华骨质疏松和骨矿盐疾病杂志， 2021 ， 14 （ 4 ）： 321 - 336 .

彭永徳 . 骨质疏松症的药物治疗进展 [J ] . 中国临床保健杂志， 2022 ， 25 （ 1 ）： 17 - 21 .

JOLETTE J ， ATTALLA B ， VARELA A ， et al . Comparing the incidence of bone tumors in rats chronically exposed to the selective PTH type 1 receptor agonist abaloparatide or PTH（1-34） [J ] . Regul Toxicol Pharmacol ， 2017 ， 86 ： 356 - 365 .

CAMACHO P M ， PETAK S M ， BINKLEY N ， et al . American association of clinical endocrinologists/American college of endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis：2020 update [J ] . Endocr Pract ， 2020 ， 26 ： 1 - 46 .

MORI T ， CRANDALL C J ， FUJII T ， et al . Cost-effectiveness of sequential daily teriparatide/weekly alendronate compared with alendronate monotherapy for older osteoporotic women with prior vertebral fracture in Japan [J ] . Arch Osteoporos ， 2021 ， 16 （ 1 ）： 72 .

刘国恩 . 中国药物经济学评价指南2020 [M ] . 北京：中国市场出版社， 2020 ： 27 - 46 .

LI N ， ZHENG B ， LIU M B ， et al . Cost-effectiveness of antiosteoporosis strategies for postmenopausal women with osteoporosis in China [J ] . Menopause ， 2019 ， 26 （ 8 ）： 906 - 914 .

DAVIS S ， SIMPSON E ， HAMILTON J ， et al . Denosumab，raloxifene，romosozumab and teriparatide to prevent osteoporotic fragility fractures：a systematic review and economic evaluation [J ] . Health Technol Assess ， 2020 ， 24 （ 29 ）： 1 - 314 .

BOW C H ， CHEUNG E ， CHEUNG C L ， et al . Ethnic difference of clinical vertebral fracture risk [J ] . Osteoporos Int ， 2012 ， 23 （ 3 ）： 879 - 885 .

MORI T ， CRANDALL C J ， GANZ D A . Cost-effectiveness of denosumab versus oral alendronate for elderly osteoporotic women in Japan [J ] . Osteoporos Int ， 2017 ， 28 （ 5 ）： 1733 - 1744 .

KLOTZBUECHER C M ， ROSS P D ， LANDSMAN P B ， et al . Patients with prior fractures have an increased risk of future fractures：a summary of the literature and statistical synthesis [J ] . J Bone Miner Res ， 2000 ， 15 （ 4 ）： 721 - 739 .

崔凯，马爱霞 . 四种二膦酸盐类药物的药物经济学评价：治疗绝经后骨质疏松症的成本效果分析 [J ] . 现代商贸工业， 2016 ， 37 （ 10 ）： 99 - 101 .

SI L ， WINZENBERG T M ， CHEN M ， et al . Screening for osteoporosis in Chinese post-menopausal women：a health economic modelling study [J ] . Osteoporos Int ， 2016 ， 27 （ 7 ）： 2259 - 2269 .

SUN S ， CHEN J Y ， JOHANNESSON M ， et al . Population health status in China：EQ-5D results，by age，sex and socio-economic status，from the National Health Services Survey 2008 [J ] . Qual Life Res ， 2011 ， 20 （ 3 ）： 309 - 320 .

YOU R X ， LIU J Y ， KE L ， et al . Cost-effectiveness of sequential teriparatide/zoledronic acid compared with zoledronic acid monotherapy for postmenopausal osteoporotic women in China [J ] . Front Public Health ， 2022 ， 10 ： 794861 .

SVEDBOM A ， BORGSTÖM F ， HERNLUND E ， et al . Quality of life for up to 18 months after low-energy hip，vertebral，and distal forearm fractures：results from the ICUROS [J ] . Osteoporos Int ， 2018 ， 29 （ 3 ）： 557 - 566 .

杜桂平，高胜男，齐冉，等 . 地舒单抗和唑来膦酸治疗绝经后骨质疏松症的成本-效用分析 [J ] . 中国药房， 2022 ， 33 （ 14 ）： 1742 - 1747 .

李梅，章振林，夏维波 . 骨质疏松症药物治疗的必由之路：长程序贯治疗 [J ] . 中华骨质疏松和骨矿盐疾病杂志， 2021 ， 14 （ 5 ）： 441 - 446 .

LUO C X ， QIN S Y ， WANG Q ， et al . Cost-effectiveness analysis of five drugs for treating postmenopausal women in the United States with osteoporosis and a very high fracture risk [J ] . J Endocrinol Invest ， 2022 ： 1 - 13 .

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