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Cost-effectiveness was demonstrated in most of the scenario simulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>A previous economic analysis estimated that 5-year denosumab was cost-effective compared with 5-year alendronate in women with postmenopausal osteoporosis (PMO) in the United States (US). Emerging literature has provided data on the long-term clinical benefits of denosumab. Therefore, the cost-effectiveness analysis was updated to understand the potential implications of a longer treatment duration (10-year) with denosumab vs generic oral alendronate or no treatment from a US third-party payer perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A lifetime Markov cohort model was used to compare 10-year denosumab treatment to 5\u00a0years of alendronate, followed by a 2-year drug holiday and, then an additional 3\u00a0years of alendronate. The target population consisted of PMO women in the US with a starting age of 72\u00a0years. Recent publicly available data, including epidemiology, treatment efficacy, persistence, and costs, were used to inform model inputs. Scenario analyses and a probabilistic sensitivity analysis (PSA) were conducted to account for uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Estimated mean total lifetime cost and quality-adjusted life years (QALYs), respectively, were $81,003 and 8.035 for denosumab, and $75,358 and 7.977 for alendronate, resulting in denosumab having an incremental cost-effectiveness ratio of $97,574 per QALY gained. At a threshold of $150,000 per QALY, the PSA demonstrated that denosumab was considered cost effective in 62.1% of simulations. Denosumab was dominant over no treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ten-year denosumab treatment would be cost-effective compared with 5\u00a0years of alendronate, followed by a 2-year drug holiday and 3\u00a0years of alendronate at the threshold of $150,000. Cost-effectiveness was demonstrated across most scenarios with robust PSA results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11657-025-01564-x","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T16:07:20Z","timestamp":1751299640000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A comprehensive update on the cost-effectiveness of 10-year denosumab vs alendronate in postmenopausal women with osteoporosis in the United States"],"prefix":"10.1007","volume":"20","author":[{"given":"Eric","family":"Yeh","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matia","family":"Saeedian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack","family":"Badaracco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"1564_CR1","doi-asserted-by":"publisher","unstructured":"NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. 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