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Osteoporosis Drug Costs Called Into Question

Osteoporosis Drug Costs Called Into Question

For 2 anabolic agents used to treat patients with osteoporosis, the incremental costs of additional quality adjusted life-years (QALYs) gained would exceed the commonly cited willingness-to-pay threshold, according to a cost-effectiveness analysis recently conducted by the Institute for Clinical and Economic Review (ICER).

ICER, a nonprofit organization that evaluates evidence on the value of medical tests, treatments, and delivery system innovations, published its final evidence report on the cost-effectiveness of the agents in mid-July after a public meeting of the California Technology Assessment Forum, which deliberated key questions raised by ICER’s initial report.

Rheumatologist Andrew Laster, MD, an expert on osteoporosis and a member of the Medical Policy Committee at United Rheumatology, the country’s largest organization of independent community-based rheumatologists, expressed concerns to Rheumatology Network about the implications of the ICER osteoporosis report.

Dire fracture consequences

Osteoporosis affects about 10 million Americans, and another 44 million have low bone density. According to the American Society for Bone and Mineral Research (ASBMR), 1 in 2 women and up to 1 in 4 men will break a bone in their lifetime because of osteoporosis, often with serious consequences. One in 4 patients older than 50 years with a hip fracture will die within a year of the fracture, ASBMR reports, and 1 in 5 will die within the following year. In addition, at least 40% will lose their independence and require long-term extended care.

Fractures also come with a high cost to the health care system. An estimated 2 million osteoporotic fractures occur each year, resulting in $19 billion in related costs. As the population of older Americans grows, these figures are predicted to increase to about 3 million fractures and $25 billion in annual costs by 2025.

FDA-approved anabolics

Two anabolic therapies are currently approved by the FDA for osteoporosis.

Teriparatide (Forteo, Eli Lilly and Co.) was the first FDA-approved osteoporosis drug that works primarily by increasing bone formation, rather than decreasing the breakdown of bone, as do antiresorptive agents. Teriparatide requires a daily injection from a prefilled pen injector, which must be kept refrigerated.

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