CLINICAL AND ECONOMIC BENEFITS OF EARLY ROMOSOZUMAB INITIATION IN PATIENTS WITH RECENT OSTEOPOROTIC HIP FRACTURES IN JAPAN
Author(s)
Saeko Fujiwara, MD, PhD1, Eric Yeh, MSc, PhD2, Etsuro Hamaya, BPharm3, Yoshito Bushita, MSc3, Satoru Tanaka, MSc3, Sudhanshu Ranjan, MSc4, Geetika Khatri, MA4, Sakshi Garg, MSc4, John R. Cook, PhD4;
1Yasuda Women’s University, Hiroshima, Japan, 2Amgen Inc., Thousand Oaks, CA, USA, 3Amgen K.K., Tokyo, Japan, 4CHEORS, North Wales, PA, USA
1Yasuda Women’s University, Hiroshima, Japan, 2Amgen Inc., Thousand Oaks, CA, USA, 3Amgen K.K., Tokyo, Japan, 4CHEORS, North Wales, PA, USA
OBJECTIVES: Among 15.9 million individuals with osteoporosis in Japan, around 193,400 experience hip fractures per year. Japanese guidelines for prevention and treatment of osteoporosis (2025) recommend osteoanabolic agents like romosozumab be used first, followed by antiresorptive agents like bisphosphonates for very-high fracture-risk patients. However, the per diem system often disincentivizes use of osteoanabolic agents at Diagnosis Procedure Combination hospitals despite guideline recommendations. This study assessed the cost-effectiveness, return on investment (ROI) and budget impact (BI) of sequence 1: romosozumab-to-alendronate, versus sequence 2: alendronate-to-romosozumab-to-alendronate, over a 5-year treatment period in patients aged ≥ 50 years with recent osteoporotic hip fractures in Japan.
METHODS: A patient-level simulation model was developed, using a 3-month cycle and a 2% annual discount rate over a 10-year horizon from the payer perspective. Baseline fracture-risk was adjusted for treatment effects via relative risk estimates. Quality-adjusted life years (QALYs) were calculated using general population utilities and fracture-specific decrements. Costs (2024 ¥) included drug acquisition, administration, disease management and fracture care costs.
RESULTS: For 100,000 patients, treatment sequence 1 yielded fewer fractures (11,800), additional life-years (7,908) and QALYs (6,533), and saved ¥15.9 billion versus sequence 2 over a 10-year horizon, making sequence 1 dominant. ROI analysis indicated a strong benefit of 607% for the payer. Further, BI decreased (approximately ¥1.2 billion) with an increased uptake of sequence 1 (from 2% to 10%). Sensitivity analyses showed consistent results with the base case. Scenario analyses comparing sequence 1 against only active vitamin D3 or alendronate indicated sequence 1 to be cost-effective at a willingness-to-pay threshold of ¥5,000,000.
CONCLUSIONS: The results of our study support that using romosozumab first in the therapeutic sequence, as per Japanese treatment guideline recommendations, is the cost-effective treatment (against delayed romosozumab, vitamin D3, alendronate) with favourable budget impact for patients aged ≥ 50 years with recent osteoporotic hip fractures in Japan.
METHODS: A patient-level simulation model was developed, using a 3-month cycle and a 2% annual discount rate over a 10-year horizon from the payer perspective. Baseline fracture-risk was adjusted for treatment effects via relative risk estimates. Quality-adjusted life years (QALYs) were calculated using general population utilities and fracture-specific decrements. Costs (2024 ¥) included drug acquisition, administration, disease management and fracture care costs.
RESULTS: For 100,000 patients, treatment sequence 1 yielded fewer fractures (11,800), additional life-years (7,908) and QALYs (6,533), and saved ¥15.9 billion versus sequence 2 over a 10-year horizon, making sequence 1 dominant. ROI analysis indicated a strong benefit of 607% for the payer. Further, BI decreased (approximately ¥1.2 billion) with an increased uptake of sequence 1 (from 2% to 10%). Sensitivity analyses showed consistent results with the base case. Scenario analyses comparing sequence 1 against only active vitamin D3 or alendronate indicated sequence 1 to be cost-effective at a willingness-to-pay threshold of ¥5,000,000.
CONCLUSIONS: The results of our study support that using romosozumab first in the therapeutic sequence, as per Japanese treatment guideline recommendations, is the cost-effective treatment (against delayed romosozumab, vitamin D3, alendronate) with favourable budget impact for patients aged ≥ 50 years with recent osteoporotic hip fractures in Japan.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE132
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)