OBJECTIVES: Romosozumab, a monoclonal antibody for osteoporosis treatment, inhibits sclerostin, increasing bone formation and decreasing bone resorption. We evaluated the incremental cost-effectiveness of treatment with romosozumab for 12 months (mo) followed by alendronate for 12 mo compared with teriparatide for 24 mo in patients with severe osteoporosis [T-score <-2.5 and fragility fracture(s)] in Greece.

METHODS: A Markov model developed in Microsoft Excel was localized to the Greek setting from the third-party payer (EOPYY) perspective. Clinical inputs were derived from the ARCH trial, a systematic literature review, and a network meta-analysis. Cost inputs were obtained from Greek public sources. The model included five health states: at risk of fracture, hip fracture, vertebral fracture, non-hip-non-vertebral fracture, and dead. All patients entered the model in the at risk of fracture state and were followed for a lifetime horizon to account for short and long-term cost and health effect consequences. Both quality-adjusted-life-years (QALY) and costs were discounted at an annual rate of 3.5%. Cost-effectiveness was reported in terms of costs per QALY gained, in 2023 Euros (€).

RESULTS: Compared with teriparatide, romosozumab followed by alendronate yielded 0.054 additional QALYs and 0.015 additional life-years. Number of patients needed to treat (NNT) to avoid one hip fracture in a lifetime horizon was 31 for romosozumab + alendronate versus 86 for teriparatide. Fracture-related medical costs were lower in the romosozumab + alendronate arm (-€298). Total incremental cost was €1,956 and cost per QALY was €36,222, which is below the perceived willingness-to-pay threshold of approximately 3 times the per capita GDP of Greece (€51,219). Model robustness and base case assumptions were validated with univariate and probabilistic sensitivity analyses.

CONCLUSIONS: According to our analysis, treatment with romosozumab (12 mo) followed by alendronate (12 mo) was cost-effective compared to teriparatide (24mo) in postmenopausal women with severe osteoporosis in Greece.