中国绝经后女性启动骨质疏松症治疗的成本效益阈值：基于真实世界数据的微观模拟分析

摘要(中文译文)

本研究基于中国规模最大的全国代表性骨质疏松调查的真实世界数据，并结合经验证的马尔可夫微观模拟模型，估算了中国绝经后女性启动骨质疏松治疗的FRAX干预阈值。地舒单抗在10年主要骨质疏松性骨折概率为7%时具有成本效益，唑来膦酸在12%时具有成本效益，而阿仑膦酸和特立帕肽在所评估的任何FRAX概率下均未达到成本效益。旨在利用真实世界数据，确定中国绝经后女性中具有成本效益地启动骨质疏松治疗（阿仑膦酸、唑来膦酸、地舒单抗、特立帕肽）的药物特异性FRAX阈值。采用经验证的马尔可夫微观模拟模型，模拟不治疗与阿仑膦酸、唑来膦酸、地舒单抗及特立帕肽治疗的终生成本和质量调整生命年（QALYs）。基线患者特征和危险因素分布取自中国大陆规模最大的全国骨质疏松调查。分析从社会视角开展，采用每获得1个QALY支付13000美元（相当于中国人均GDP的1倍）的支付意愿阈值。地舒单抗在10年主要骨质疏松性骨折概率为7%时具有成本效益，唑来膦酸在12%时具有成本效益；阿仑膦酸和特立帕肽均未达到成本效益。对于地舒单抗，10年主要骨质疏松性骨折概率的成本效益阈值随年龄从51岁至65岁而升高，随后在更年长女性中下降，范围为5%至12%。对于唑来膦酸治疗，10年主要骨质疏松性骨折概率的成本效益阈值在51~55岁为8%，在71~75岁为12%，在76~80岁为8.5%。对于中国绝经后女性，地舒单抗是最具成本效益的治疗，而唑来膦酸在特定年龄组中也达到了有利阈值。实施药物特异性FRAX®指导的阈值可优化骨质疏松治疗决策，并支持高效的医疗资源利用。

Abstract

This study estimated FRAX-based intervention thresholds for initiating osteoporosis treatment in Chinese postmenopausal women, using real-world data from the largest nationally representative osteoporosis survey in China and a validated Markov microsimulation model. Denosumab became cost-effective at a 10-year major osteoporotic fracture probability of 7%, and zoledronate at 12%, whereas alendronate and teriparatide did not reach cost-effectiveness at any FRAX probability evaluated. To determine drug-specific FRAX thresholds for cost-effective initiation of osteoporosis treatment (alendronate, zoledronate, denosumab, teriparatide) in Chinese postmenopausal women using real-world data. A validated Markov microsimulation model was used to simulate lifetime costs and quality-adjusted life years (QALYs) of no treatment versus alendronate, zoledronate, denosumab, and teriparatide treatment. Baseline patient characteristics and risk factor distribution were sampled from the largest national osteoporosis survey in mainland China. The analysis was conducted from the societal perspective, applying a willingness-to-pay threshold of USD 13,000 per QALY gained (equivalent to one times China's GDP per capita). Denosumab was cost-effective at a 10-year major osteoporotic fracture probability of 7% and zoledronate at 12%; neither alendronate nor teriparatide became cost-effective. For denosumab, the cost-effective threshold of 10-year major osteoporotic fracture probability increased with age from 51 to 65 years and then declined in older women, ranging from 5 to 12%. For zoledronate treatment, the cost-effective thresholds of a 10-year major osteoporotic fracture probability were 8% at 51-55 years, 12% at 71-75 years, and 8.5% at 76-80 years. For Chinese postmenopausal women, denosumab was the most cost-effective treatment, while zoledronate also reached favorable thresholds in selected age groups. Implementing drug-specific FRAX®-guided thresholds may optimize treatment decisions for osteoporosis and support efficient healthcare resource use.

如何引用

Archives of osteoporosis 的其他文献

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