OBJECTIVES: Denosumab is cost-effective in osteoporotic fracture prevention in Caucasian populations, however, economic evidence is still lacking in China. This study aimed to determine a cost-effective price for denosumab in China, based on its clinical fracture prevention, safety and adherence profile.

METHODS: A validated Chinese health economics model of osteoporosis [1] was used to project lifetime costs and effectiveness of secondary fracture prevention with 1)denosumab, and 2)current treatment in China (a mix of calcitonin, alendronate, calcium and vitamin D). Relative risk of hip, vertebral and other fracture with denosumab treatment was assumed at 0.60(95% CI: 0.37-0.97), 0.32(95% CI: 0.26-0.41) and 0.80(95% CI: 0.67-0.95) respectively [2]. First- and second-order Monte-Carlo simulations were conducted in hypothetical Chinese women aged 65 years without previous fractures. Patient characteristics were accounted for. Costs were expressed in 2016 US dollars. The willingness-to-pay (WTP) threshold was set at USD 24,000 (3 times per capita GDP in China) per quality-adjusted life year (QALY) gained. The perspective of the health insurer was adopted. Costs and effectiveness were discounted at 3% annually.

RESULTS: Denosumab was cost-effective in Chinese women with a price<$755/injection: lifetime costs and effectiveness for current treatment group were $4,953 and 8.72 QALYs and for the denosumab group $8,546 (at $755/injection) and 8.87 QALYs.

CONCLUSIONS: Denosumab is currently not publicly reimbursed in China and it is potentially cost-effective in the Chinese setting. Valued-based pricing conducted in country-specific settings can be used to determine maximum prices at which interventions are cost-effective. Our study might be informative to pharmaceutical companies when they determine the price of denosumab in the Chinese market.

REFERENCES 1. Si et al (2015). Osteoporosis Int 26(5), 1477-1489. 2. Cummings et al (2009). NEJE. 361(8), 756-765.