Osteoporosis cost-effectiveness of therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

44 million people of more than 50 years old in the US are suffering from osteoporosis, more than half of over 50 years people. Remaining the current conditions and utilities, it is estimated that more than 61 million people in 2020 would be suffering from osteoporosis. Women constitute 80% of the osteoporotic population. Parathormone (PTH) analogues (teriparatide and abaloparatide) have more prices and quality-adjusted life years (QALYs) in contrast with zoledronate. Teriparatide and abaloparatide are $43,440 and $22,061 more costly than zoledronate. In Europe the whole cost of medical therapies for osteoporosis in 2010 was €37 billion, in which 66% was for acute fractures management, 29% was for long-term fracture outcome management, and 5% was for medical prevention. On the other hand, the holistic burden of osteoporosis in Europe assumed to be the loss of 1,180,000 life years (QALY), most of them because of prior osteoporotic fractures. Regarding that one QALY is equal value of 2xGDP, it is assumed that the total burden of osteoporosis become €60.4 billion, in 2010. Surprisingly, the QALY number will rise from 1.2 million in 2010 to about 1.4 million years in 2025, with 20% increase.  

Cost-Effectiveness of Therapy

Osteoporosis - Incidence and burden

Europe

  • In most of the European countries, bone mineral density (BMD) measurements are not so utilized; it is assumed to be due densitometers limited availability, limited technicians in charge of performing scans, low attitude and insight in using the test, and limited or nonexistent reimbursement.[10]
  • WHO estimation of the osteoporosis population in Europe is 22 million females and 5.5 million males in 2010 (total of 27.5 million); which is going to rise about 23% until 2025 (total of 33.9 million). New fractures in the EU during 2010 was estimated at 3.5 million, including approximately 620,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures and 1,800,000 other fractures. The number of fractures in a year assumed to grow from 3.5 million in 2010 to 4.5 million in 2025, suggesting a 28% increase. 43,000 people have died in 2010 because of osteoporosis complications. It is assumed that osteoporotic fractures are the main reason of 26,300 life-year lost in Europe, in 2010.[11]
  • In Europe the whole cost of medical therapies for osteoporosis in 2010 was €37 billion, in which 66% was for acute fractures management, 29% was for long-term fracture outcome management, and 5% was for medical prevention. On the other hand, holistic burden of osteoporosis in Europe assumed to be loss of 1,180,000 life years (quality adjusted (QALY)), most of them because of prior osteoporotic fractures. Regarding that one QALY is equal value of 2xGDP, it is assumed that the total burden of osteoporosis become €60.4 billion, in 2010. Surprisingly, the QALY number will raise from 1.2 million in 2010 to about 1.4 million years in 2025, with 20% increase.[11]
The economic burden of osteoporosis, in 2010 and 2025[12]
Country New osteoporotic fractures

in 2010

People over 50 with osteoporosis

in 2010

Economic burden each year Economic burden

by 2025

Increase percentage

by 2025

Germany 725,000 5,020,000 € 9 billion (€ 9,008 million) € 11.2 billion (€11,261 million) 25%
UK 536,000 3,210,000 £ 3,496 (€ 5,408) million £ 5,465 (€ 6,723) million 24%
France 377,000 3,480,000 € 4,853 million € 6,111 million 26%
Spain 204,000 2,450,000 € 2,842 million € 3.68 billion 30%
Sweden 107,000 520,000 € 1,486 million € 1.8 billion (€ 1,828 million) 23%
Denmark 66,000 280,000 € 1,055 million €1.3 billion (€ 1,344 million) 27%
Greece 86,000 640,000 € 680 million € 814 million 20%
Belgium 80,000 600,000 € 606 million € 733 million 21%
Romania 94,000 590,000 € 577 million € 151 million 17%
Czech Republic 72,000 530,000 € 273 million € 352 million 29%
Slovenia 16,000 590,000 € 56 million € 77 million 37%

Denmark

  • From 1987-1997, in a 10-year period, the rate of osteoporosis increased by 56%; among which 41% was in women and 104% was in men, more than 50 years old.[13]

Finland

  • Hip fracture rate increased by 70% from 1992 to 2002, in a 10-year period.[14]

Georgia

  • It is assumed that only one patient with hip fracture out of four is seeking hospital care.[15]

Germany

  • A study of fracture rate showed that 45% of men and 31% of women between 25 to 74 years old experience fracture; while 42% of men and 40% of women between 65 to 74 years old encounter fractures.[16]

Greece

  • Hip fracture rate was increased by 7.6% from 1977 until 1992, in a five year period.[17]

Kazakhstan

  • Due to some various factors, more than half of the people with hip fracture are not hospitalized. Whereas more than 70% are not admitted for hip surgery.[18]

Romania

Russia

  • 14 million people (about 10%) are involved in osteoporosis, while 20 million suffer from osteopenia; however, Russia has 34 million high fracture risk people. It is assumed that in some cities 45-52% of patients with a severe osteoporotic fracture have not suitable hospitalization or surgery until 1 year. Among those patients with hip fracture who could survive, only about 10% would have previous daily activity level.[18]

Slovenia

  • General hip fracture rate has been increased by 40% from 1998 to 2005, a seven year period.[18]

Spain

  • The increase rate of new hip fracture case was 54% from 1998 to 2002, a 14-year period. However, the women (64%) were more increased than men (19%).[19]
  • The fracture was leading to demise of 13% of patients after 3 months, and 38% of them after 24 months. Furthermore, patients suffered from vertebral fracture would experienced loosing functionality (45%) or disability (50%).

Sweden

Switzerland

  • It is predicted that with maintaining the current conditions of osteoporotic prevention and treatment, in a 20 years period from 2000, the osteoporotic fracture rates of hip, vertebrae, and wrist grow by 33%, 27%, and 19%, respectively.[22]

Ukraine

UK

  • Half of women and one-fifth of men would have fracture when pass 50 years of age.[24]

North America

Canada

  • About one and half million Canadians, mostly postmenopausal and elderly are suffering from osteoporosis. 25% of women and 12.5% of men of more than 50 years old experience degrees of vertebral fractures. It is assumed that total amount of hip fractures are 30,000 occurrence, annually; which it to grow to quadruple measure until 2030. [25]

USA

  • 44 million people of more than 50 years old in US are suffering from osteoporosis, more than half of over 50 years people. Remaining the current conditions and utilities, it is estimated that more than 61 million people in 2020 will involved in osteoporosis. Women are 80% of the osteoporotic population.[26]

Antiresorptive drugs' cost input table, based on National Osteoporosis Foundation (NOF), 2017[26]

Drug Name, Labeled Dose, Administration Route Strength

(Pen Size)

Pen cost Net Price

after modulation

Base-Case Tx Duration Acquisition Cost Per Tx Course
Teriparatide 20 mcg SC QD 250 mcg/ml (2.4 ml) $2,997.90 $1,866.34 2 years $48,691
Abaloparatide 80 mcg SC QD 3,120 mcg/1.56 ml $1,625 $1,186.25 2 years $29,312
Zoledronic Acid 5 mg IV Q year 5 mg/100 ml $306 $306 6 years $1,837

PTH analogues (teriparatide and abaloparatide) have more prices and QALYs in contrast with zoledronate. Teriparatide and abaloparatide are $43,440 and $22,061 more costly than zoledronate.

Latin America

  • It is estimated that in a period of 60 years, from 1990 to 2050, Latin America are experiencing a 5 times increase in hip fracture, in men and women between 50 to 64 years of age. Surprisingly, it will be 8 times for age of more than 65 years.[27]
  • Regarding 655,648 hip fractures in 2050, it will directly cost about $13 billion.[28]
  • 23% to 30% of the patients with hip fracture will die in the first year after fracture, more in men compared to women.[29]
  • Vertebral fractures prevalence in women more than 50 years of age is 15%, in which 7% is among 50-60 years and 28% is among more than 80 years women.[30]

Argentina

  • Half of the over 50 years women suffer from osteopenia and one fourth of them involved in osteoporosis. It is estimated to be 5.24 million osteopenic and 2.62 million osteoporotic women in 2050. Population of above 50 years old are encountering 90 hip fractures a day (34,000 per year). It will be more than 63,000 one in women and more than 13,000 in men, by 2050. Vertebral fracture rate in postmenopausal women is 16.2%. Total burden of both hip and vertebral osteoporotic fractures, including hospitalization costs, is more than $190 million per each year.[31]

Brazil

  • One person in every 17 people, totally about 10 million people are suffering from osteoporosis. 37.5% of men and 21% of women would have osteoporotic fracture during life.[32] One person in every 3 patients encountering hip fracture would have osteoporosis, however, one out of five will receive treatment.[33] The total economic burden of osteoporotic fracture is assumed to be $6 million.[34]

Chile

  • 46% of women of more than 50 years of age were osteopenic and 22% were osteoporotic, in 1985.

Mexico

Venezuela

  • 5.5% of women and 1.5% men of 50 years of age would have hip fracture. For other sites of fractures the percentages are 13.6% and 3.5% for women and men, respectively. It is assumed that 9.6 hip fracture a day in 1995, will grow to 67 fractures a day in 2030. After 70 years of age only one out of ten people may have normal bone mineral density.[36]

Middle East and Africa

  • Vitamin D deficiency is really prevalent in this region, despite vast majority of day hours sun there. The rate of death after osteoporotic fracture in the area is 2-3 times of Western societies. The major reason for the issue is lack of utilities, less than one DXA scan for 1 million people in country of Morocco.[37]

Egypt

Iran

  • In 2010, the hip fracture rate was 50,000, and will become 62,000 in 2020. The hip fracture rate of Iran is 0.85% of worldwide and 12.4% of Middle east whole burden.[39]

Jordan

  • Hip fractures are growing from 1008 per year in 2008 to four times of the original size in 2050.[18]

Lebanon

  • The age and BMD measures in patients with hip fractures are different from other countries, they are younger and osteopenic instead of old and osteoporotic.[40]

Saudi Arabia

Syria

  • From approximately 15,000 vertebral osteoporotic fractures per year, only one-fifth seek medical services.[18]

Turkey

  • It is assumed that 24,000 hip fracture in male and female above 50 years of age will become 36,000 in 2020.[42]

Asia

  • In 2050, more than half of the whole hip fractures of the world would be from Asia. The main reason is improving the utilities and developing the medical services availability; currently, more than half of the population of China are living in rural area, managing fractures conservatively at home and not seeking any medical services. On the other hand major facilities, like densitometers, will become more accessible for everyone.[43]

China

  • 70 million cases of osteoporosis are leading to 678,000 hip fractures, annually. Men are more suffering from hip fracture than women. The holistic prevalence of osteoporosis in women is about two folds of men. Total economic burden of one hip fracture is about $3,603, which may measured as $1.5 billion per year. It is assumed to grow to $12.5 billion in 2020 and more than $ 264.7 billion in 2050. Facility limitation is the major problem of China in managing osteoporosis; in 2008 the whole DXA scanners number for the whole 1.3 billion Chinese was 450. [44][45]

Hong Kong, China

  • For a 6 million population, hip fracture management are in charge of 1% of whole hospital economic burden, $17 million.[46]

India

Japan

Korea

  • In a 10-year period, number of hip fractures raised 300%. In people more than 75 years hip fracture occurs in 4.3 per 1000 women and 2.97 per 1000 men.

Singapore

  • Hip fracture in men and women have became 1.5 times and 5 times, respectively, in 1998 compared to 1960's.[50]

Oceania

Australia

  • Total economic burden of the osteoporosis is $7.4 billion, annually. Whole number of osteoporosis are 2.2 million cases, while 42% of men and 51% of women are encountering bone density loss. Lifetime risk of women for fragility fractures is about twice the risk of men.[51]

New Zealand

  • Total economic burden of osteoporosis is more than $1.15 billion, annually. It is assumed to be increased by more than 30%, in 2020. Women encounter osteoporotic fractures more than men. 5% of all fractures occurred in hip[52]

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