Abstract

Objectives

To calculate the cost-effectiveness ratio and the budget impact of teriparatide use in men with severe osteoporosis and history of fractures in Brazil.

Methods

Three hypothetical cohorts of men with severe osteoporosis and history of fracture, with initial ages of 50, 60, and 70 years, were simulated using a Markov Model to calculate the cost-effectiveness ratio between teriparatide and alendronate and risedronate, from the perspective of the Unified Health System (SUS). The time horizon was 10 years, with cycles of 1 year. Effectiveness outcomes were measured in quality-adjusted life-years (QALY). Deterministic and probabilistic sensitivity analyses were performed.

Results

Teriparatide compared with alendronate and risedronate has an incremental cost-effectiveness ratio of 77,002/79,808 R$/QALY, 305,435/439,636 R$/QALY, and 327,869/460,333 R$/QALY for 50, 60, and 70 years, respectively. The deterministic and probabilistic evaluations did not produce results that altered the previous conclusion and, in all situations, the teriparatide was not cost-effective for a threshold of R$ 40,000.00/QALY. The analysis of the budget impact estimated that the use of teriparatide for a market share of 60% in 5 years would have an additional cost of approximately R$ 187 million.

Conclusions

In the analyzed scenarios, the use of bisphosphonates produces resource savings in relation to teriparatide in the treatment of men. Teriparatide was not cost-effective in any situation.