Teriparatide in the Treatment of Severe Postmenopausal Osteoporosis: A Cost-Utility Analysis in 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.