Background/Purpose: Patients with multiple previous fractures are at very high risk of subsequent fractures. Common treatment strategies for these patients include generic alendronate (ALN) monotherapy or sequential therapy with an anabolic agent first (such as abaloparatide [ABL] or teriparatide [TPTD]) followed by generic ALN. Due to mounting pressure on healthcare systems, cost-effectiveness analyses are increasingly important to support decision makers in efficient healthcare resource allocation. This study was designed to evaluate the cost-effectiveness of sequential treatment with ABL followed by ALN compared to relevant alternative strategies in women and men with two previous fractures in the United States (US).

Methods: A lifetime microsimulation model estimated the US healthcare costs (in 2022 dollars) and quality-adjusted life years (QALYs) associated with sequential ABL/ALN and three relevant comparators: (1) a similar sequence beginning with unbranded TPTD; (2) generic ALN monotherapy; and (3) no treatment, which must be included as a comparator as many patients at very high fracture risk do not receive an osteoporosis medication. The analyses were conducted in men and women aged 50 to 90 years with two previous fractures and densitometric osteoporosis (bone mineral density T-score ≤−2.5). Sequential ABL/ALN is considered dominant if it is associated with more QALYs for lower costs than the comparator strategy, and is cost-effective if the cost per QALY gained falls below the US cost-effectiveness threshold of $150,000 per QALY gained. Various scenarios and sensitivity analyses were conducted to investigate uncertainty, including analyses on gender, age (50-90 years), and site of previous fractures.

Results: In both US women and men aged 50-90 years, sequential ABL/ALN was dominant compared to sequential unbranded TPTD/ALN. The costs per QALY gained of sequential ABL/ALN compared to no treatment were below the cost-effectiveness threshold in men aged ≥50 years with two previous fractures, in women aged ≥55 years with two previous fractures, and those aged ≥50 years with history of hip or vertebral fracture. When compared to ALN monotherapy, the costs per QALY gained of sequential ABL/ALN were estimated at $82,288 and $111,584 in men and women aged 70 years with two previous fractures, respectively. These numbers decreased to $35,283 and $66,707 with history of hip fracture. Sequential ABL/ALN was further cost-effective in men ≥50 years with two previous fractures, in women ≥55 years with two previous fractures including a hip or vertebral fracture, and in women ≥65 years for other types of fractures.

Conclusion: Sequential ABL/ALN is dominant in all analyses completed compared to unbranded TPTD/ALN and is cost-effective compared to generic ALN monotherapy in men aged ≥50 years, in women aged ≥55 years with history of hip or vertebral fracture, and in women aged ≥65 years with other fracture types.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cost-effectiveness-analysis-of-sequential-treatment-with-abaloparatide-followed-by-alendronate-in-us-women-and-men-with-multiple-previous-fractures/