PHARMAC responds on agents to prevent osteoporotic fractures [1]

New Zealand Medical Journal

Volumn 119, Issue 1230, 2006, Pages

  Metcalfe, Scott ^a   Wilkinson, Tommy ^a   Rasiah, Dilky ^a  

^a PHARMAC ^*  (New Zealand)

Author keywords

[No Author keywords available]

Indexed keywords

ALENDRONIC ACID; BISPHOSPHONIC ACID DERIVATIVE; CALCITRIOL; ETIDRONIC ACID; HORMONE; PARATHYROID HORMONE; RALOXIFENE;

CLINICAL TRIAL; COST EFFECTIVENESS ANALYSIS; DRUG COST; DRUG INDUSTRY; FRAGILITY FRACTURE; HEALTH CARE FINANCING; HEALTH CARE ORGANIZATION; HIP FRACTURE; HORMONE SUBSTITUTION; HUMAN; LETTER; MEDICAL DECISION MAKING; QUALITY ADJUSTED LIFE YEAR; UNSPECIFIED SIDE EFFECT; VERTEBRA FRACTURE; WRIST FRACTURE;

EID: 33646136220     PISSN: 11758716     EISSN: 11758716     Source Type: Journal    
DOI: None     Document Type: Letter

References (18)

1. Watts NB, Harris ST, Genant HK, et al. Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med. 1990;323:73-9.
2. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996;348:1535-41.
3. Ensrud KE, Black DM, Palermo L, et al. Treatment with alendronate prevents fractures in women at highest risk: results from the Fracture Intervention Trial. Arch Intern Med. 1997;157:2617-24.
4. PharmHouse data, numbers of scripts for alendronate 10 mg and 70 mg tablets or for etidronate, dispensed during December 2005.
5. 10.
6. Cost-effectiveness estimates varied widely according to baseline fracture risks (in turn exponentially related to age, for instance). These ranged from $11,700/QALY for higher risk patients [women aged ≥:70 and BMD <0.59 and multiple vertebral factures and a history of postmenopausal fracture] to $103,300/QALY for lower risk patients [women aged <75 and BMD ≥0.59 and single vertebral fracture and no history of postmenopausal fracture].
7. For patients with T-score <-3.0 SDs and 2+ fragility fractures, PHARMAC models used estimated baseline 7.1% clinically significant factures per year on placebo, reducing to 3.4% with alendronate - an absolute risk reduction of 3.6% fewer clinically-significant fractures per year after rounding.
8. Estimated baseline 5.5% clinically significant factures per year, reducing to 2.7% with alendronate - an absolute risk reduction of 2.8% fewer clinically-significant fractures per year.
9. Alendronate for osteoporosis. PHARMAC Technology Assessment Report No. 9, November 1999.
10. Expanding access to alendronate in the Pharmaceutical Schedule for the treatment and prevention of osteoporosis. PHARMAC Technology Assessment Report No. 70, August 2005.
11. Kanis JA, Borgstrom. F, De Laet C, et al. Assessment of fracture risk. Osteoporos Int. 2005;16:581-9. Epub 2004 Dec 23.
12. For New Zealand's access criteria for alendronate 10 and 70 mg tables, see http://www.pharmac.govt.nz/interactive/scripts/ restrict.ast?code=140402+10370101 etc. and http://www.pharmac.govt.nz/interactive/scripts/product.asp?code=140402
13. For Australia, see http://www1.health.gov.au/pbs/scripts/dispther.cfm?1v13id= 26944&sched=GA&1v13name=Drugs%20affecting%20bone%20structure% 20and%20mineralization&1v12name=Drugs%20for %20treatment%20of% 2Obone%20diseases&1v11name=Musculo%2Dskeletal%20system
14. PTAC considered that there was a need for a treatment of osteoporosis in patients who could not tolerate an oral bisphosphonate. The Committee considered that raloxifene was less efficacious than alendronate in the treatment of osteoporosis, but may be a suitable alternative if raloxifene could be targeted to patients who were genuinely intolerant to bisphosphonates.
15. Minutes of the Pharmacology and Therapeutics Advisory Committee Meeting 21 February 1997.
16. Minutes of the Osteoporosis Treatments Subcommittee of the Pharmacology and Therapeutics Advisory Committee Meeting 10 June 1997.
17. PHARMAC. A prescription for pharmacoeconomic analysis (version 1), 24 September 1999. A minor update in 2004 (version 1.1) can be found at http://www.pharmac.govt.nz/pdf/pfpa.pdf
18. PHARMAC. Recommended methods to derive clinical inputs for proposals to PHARMAC (version 1B), 20 July 2005. http://www.pharmac.govt.nz/pdf/62465.pdf (referred to at http://www.pharmac.govt.nz/funding_applications.asp)