OBJECTIVES: In South Korea, 22.3% of women aged≥50 years, and 37% of women aged≥70 years visit doctors for the treatment of osteoporosis. According to the analysis of the National Health Insurance Services claim data from 2008 to 2012, numbers and incidence of hip and vertebral fractures were on the rise during the same period. Denosumab is a newly marketed medicine in South Korea, which is the first RANK ligand (RANKL) inhibitor. The cost-utility analysis was conducted with societal perspectives in order to evaluate denosumab’s value compared to alendronate in South Korea.

METHODS: A Markov cohort model was used to investigate the cost-effectiveness of denosumab. The 6-month cycle length was applied to the model and all patients were individually followed through the model from the age of treatment initiation to their time of death or at age of 100 years. The model consisted of eight health states: well, hip fracture, vertebral fracture, wrist fracture, other osteoporotic fracture, post hip fracture, post vertebral fracture, and dead. All patients began in the well health state. The 5% discounted rate, two-year maximum offset time and persistence were adopted in this model.

RESULTS: Total life time cost for alendronate and denosumab were USD 5,564 and USD 6,086, respectively. The incremental cost-effectiveness ratio (ICER) for denosumab versus alendronate was USD 8,283/ QALY, Given the ICER threshold in Korea, the result showed that denosumab was dominant over alendronate.

CONCLUSIONS: Denosumab is a cost-effective alternative over the oral anti-osteoporotic treatment, alendronate in South Korea.