Document Type: Research article
Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences.
Department of Pharmacoeconomics and Pharma management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Background: Teriparatide is a new agent serves as a treatment of choice for severe post-menopausal osteoporotic patients who are at a high risk of fracture or have failed or been intolerant of previous osteoporosis therapy. The objective of this study is estimating the cost-utility of Teriparatide compared with no treatment from health system perspective in Iran.
Method: A microsimulation model was developed for a cohort of hypothetical Iranian patient population (women aged 70 years, T-score -2.5 with previous fracture or T-score -3.0 without prior fracture) over lifetime horizon. The model consisted of seven health states. During each cycle, patients could have a fracture, remain healthy, remain in a post-fracture state or die.
Background fracture risks, mortality rates, persistence rates, utilities, medical and drug costs were derived using published sources. Total accumulated life-time costs and quality-adjusted life years (QALYs) were estimated.
Result: Teriparatide was associated with 4.786 QALYs and total direct costs of IRR 143,168,259 over a lifetime horizon. Compared to no treatment, Teriparatide provided an additional 0.145 QALY at an incremental cost of IRR 33,511,013. The resulting incremental cost-effectiveness ratio was IRR 230,333,030/QALYs gained. The probabilistic analysis showed that accepting a willingness-to-pay 2 and 3 GDP/capita in Iran, the probability of Teriparatide being cost-effective were 51% and 83%, respectively.
Conclusion: Compared to no treatment, Teriparatide was indicated to be more costly and associated with fewer fractures, more life-years, and more QALYs. The result showed that Teriparatide may be considered a cost-effective intervention when targeted to the appropriate patients.