Compared with teriparatide and alendronate, sequential therapy consisting of abaloparatide and alendronate is more cost-effective in treating women at high risk for fragility fracture, according to study results published in Seminars in Arthritis and Rheumatism.

Researchers adapted a previously validated Markov microsimulation model to compare the cost-effectiveness of these 2 sequential therapies (osteoanabolic agents followed by an antiresorptive), which can be used to mitigate osteoporosis and reduce risk for fracture. Included participants (aged 50-80 years) had either a bone mineral density T-score ≤-3.5 and no history of fracture or a bone mineral density T-score between -2.5 and -3.5 and at least 1 osteoporotic fracture.

Based on the 2016 American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guideline for osteoporosis, participants were assumed to receive 18 months of abaloparatide or teriparatide followed by 5 years of alendronate.

In all simulation populations, sequential therapy of abaloparatide and alendronate was dominant over teriparatide and alendronate, with the former yielding lower overall costs and more quality-adjusted life-years. The researchers attributed this to the improved efficacy and lower price of abaloparatide.

Using probabilistic sensitivity analyses, the researchers also concluded that abaloparatide plus alendronate therapy was dominant in ≥99% of conducted simulations. Furthermore, compared with no treatment, the abaloparatide and alendronate combination was cost-effective at a threshold of $100,000/quality-adjusted life-years gained in 86%, 97.5%, 100%, and 100% of the simulations at ages 50, 60, 70, and 80 years, respectively.

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Limitations to this study included an absence of cost-effectiveness estimates for therapies other than teriparatide and alendronate and no treatment.

“This study suggests that sequential therapy beginning with [abaloparatide] followed by [alendronate] is a cost-effective strategy for [women in the United States] at increased risk [for] fractures,” the researchers said, adding that the findings were robust in all 1-way and probabilistic sensitivity analyses.

This study was funded by Radius Health, Inc., which markets abaloparatide. Multiple authors also declared associations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

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Reference

Hiligsmann M, Williams SA, Fitzpatrick LA, Silverman SS, Weiss R, Reginster J. Cost-effectiveness of sequential treatment with abaloparatide vs. teriparatide for United States women at increased risk of fracture [published online January 10, 2019]. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2019.01.006