Cost Effectiveness of Ibandronate for the Prevention of Fractures in Inflammatory Bowel Disease-Related Osteoporosis: Cost-Utility Analysis Using a Markov Model
Simon Kreck (Health Economics Research Unit, University of Leipzig, Leipzig, Germany) Jochen Klaus (Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany) Reiner Leidl (Institute for Health Economics and Health Care Management, Helmholtz Zentrum Munchen, German Research Center for Environmental Health, Neuherberg, Germany) Christian von Tirpitz (Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany) Alexander Konnopka (Health Economics Research Unit, University of Leipzig, Leipzig, Germany) Herbert Matschinger (Department of Psychiatry, University of Leipzig, Leipzig, Germany) Hans-Helmut Konig (Health Economics Research Unit, University of Leipzig, Leipzig, Germany)
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Background: Osteoporosis is a frequent complication in patients with inflammatory bowel disease. Recent studies have shown bisphosphonates to considerably reduce fracture risk in patients with osteoporosis, and preventing fractures with bisphosphonates has been reported to be cost effective in older populations. However, no studies of the cost effectiveness of these agents in preventing fractures in patients with inflammatory bowel disease are available. Objective: To investigate the cost effectiveness of the bisphosphonate ibandronate combined with calcium/colecalciferol ( Study design and methods: A cost-utility analysis was conducted using data from a randomized controlled trial (RCT). Changes in bone mineral density (BMD) were adjusted and predicted for a standardized population receiving each respective treatment. A Markov model was developed, with probabilities of transition to fracture states consisting of BMD-dependent and -independent components. The BMD-dependent component was assessed using predicted change in BMD from the RCT. The independent component captured differences in bone quality and micro-architecture resulting from prevalent fractures or treatment with anti-resorptive drugs. The analysis was conducted for a population with a mean age of the RCT patients (women aged 36 years, men aged 38 years) with osteopenia (T-score about -2.0 at baseline), a population of the same age with osteoporosis (T-score of -3.0 at baseline) and for an older population (both sexes aged 65 years) with osteoporosis (T-score of -3.0). Outcomes were measured as costs per QALY gained from a societal perspective. The treatment duration in the RCT was 42 months. A 5-year period was assumed to follow, during which the treatment effects linearly declined to 0. The simulation time was 10 years. Prices for medication and treatment were presented as year 2004 values; costs and effects were discounted at 5%. To test the robustness of the results, univariate and probabilistic sensitivity analyses (Monte Carlo simulation) were conducted. Results: The calcium strategy dominated the fluoride strategy. When the ibandronate strategy was compared with the calcium strategy, the base-case cost-effectiveness ratios (costs per QALY gained) were between Conclusion: The ibandronate strategy is unlikely to be considered cost effective by decision makers in men or women with characteristics of those in the target population of the RCT, or in older populations with osteoporosis.
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Article provided by Wolters Kluwer Health | Adis in its journal PharmacoEconomics.
Volume (Year): 26 (2008) Issue (Month): 4 () Pages: 311-328 Download reference. The following formats are available: HTML,
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