What are we paying for? A cost-effectiveness analysis of patented denosumab and generic alendronate for postmenopausal osteoporotic women in Australia

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dc.contributor.authorKarnon, J.
dc.contributor.authorShafie, A.
dc.contributor.authorOrji, N.
dc.contributor.authorUsman, S.
dc.date.issued2016
dc.description.abstractZoledronic acid and denosumab were funded by the Australian government for the management of osteoporosis at an equivalent price to alendronate. The price of alendronate has declined by around 65 %, but the price of the other two therapies has remained stable. Using data published since the listing, this paper reports current estimates of the value of denosumab compared to alendronate from an Australian health system perspective.A cohort-based state transition model was developed that predicted changes in bone mineral density (BMD), and calibrated fracture probabilities as a function of BMD, age and previous fracture to estimate differences in costs and QALYs gained over a 10-year time horizon.The base-case incremental cost per QALY gained for denosumab versus alendronate was $246,749. There is a near zero probability that denosumab is cost-effective at a threshold value of $100,000 per QALY gained. If the price of denosumab was reduced by 50 %, the incremental cost per QALY gained falls to $50,068.Current Australian legislation precludes price reviews when comparator therapies come off patent. The presented analysis illustrates a review process, incorporating clinical data collected since the original submission to inform a price at which denosumab would provide value for money.
dc.description.statementofresponsibilityJonathan Karnon, Ainul Shakirah Shafie, Nneka Orji and Sofoora Kawsar Usman
dc.identifier.citationCost Effectiveness and Resource Allocation, 2016; 14(1):11-1-11-10
dc.identifier.doi10.1186/s12962-016-0060-5
dc.identifier.issn1478-7547
dc.identifier.issn1478-7547
dc.identifier.orcidKarnon, J. [0000-0003-3220-2099]
dc.identifier.urihttp://hdl.handle.net/2440/108495
dc.language.isoen
dc.publisherBioMed Central
dc.rights© 2016 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/)applies to the data made available in this article, unless otherwise stated.
dc.source.urihttps://doi.org/10.1186/s12962-016-0060-5
dc.subjectPharmaceutical pricing
dc.subjectPatent
dc.subjectGeneric
dc.subjectOsteoporosis
dc.subjectCost-effectiveness
dc.subjectCalibration
dc.titleWhat are we paying for? A cost-effectiveness analysis of patented denosumab and generic alendronate for postmenopausal osteoporotic women in Australia
dc.typeJournal article
pubs.publication-statusPublished

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