{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:13:36Z","timestamp":1792098816601,"version":"4.4.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T00:00:00Z","timestamp":1647561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> The primary purpose of this study was to estimate the cost-effectiveness of sequential denosumab\/zoledronic acid versus zoledronic acid monotherapy for postmenopausal osteoporotic women in China.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> We updated and utilized a previously validated Markov microsimulation model to obtain the cost-effectiveness of two strategies for treating postmenopausal osteoporotic women. We compared the incremental cost-effectiveness ratios (ICERs) (US dollars [$] per quality-adjusted life year [QALY]) of sequential denosumab\/zoledronic acid (i.e., biannual subcutaneous denosumab for 3 years followed by annual intravenous zoledronic acid for 3 years) with zoledronic acid monotherapy for 3 years in Chinese women with postmenopausal osteoporosis at ages 65, 70, 75, and 80 from the health care payer perspective. Our study\u2019s willingness-to-pay (WTP) threshold was set to three times the value of China\u2019s per capita GDP in 2020 ($31,512).<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The ICERs of sequential denosumab\/zoledronic acid versus zoledronic acid monotherapy were $59,389\/QALY, $23,821\/QALY, $22,710\/QALY, and $14,027\/QALY at age 65, 70, 75, and 80 years, respectively. One-way sensitivity analyses showed that the most impactful parameter was the persistence rate of the medications. If the persistence rate of denosumab or zoledronic acid was increased by 10%, sequential denosumab\/zoledronic acid would be cost-effective at age 65. In probabilistic sensitivity analyses, the probabilities of sequential denosumab\/zoledronic being cost-effective compared to zoledronic acid monotherapy were approximately 29.3%, 68.7%, 86.1%, and 99.4% for ages 65, 70, 75, and 80 years, respectively, at the WTP threshold of $31,512\/QALY.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Among Chinese postmenopausal osteoporosis women over 70 years old, sequential denosumab\/zoledronic acid was cost-effective compared with zoledronic acid monotherapy at the pre-determined WTP threshold.<\/jats:p>","DOI":"10.3389\/fphar.2022.816248","type":"journal-article","created":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T05:37:15Z","timestamp":1647581835000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Cost-Effectiveness of Sequential Denosumab\/Zoledronic Acid Compared With Zoledronic Acid Monotherapy for Postmenopausal Osteoporotic Women in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Ruxu","family":"You","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinyu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Ke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Wan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangyi","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Mori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1910","DOI":"10.1002\/jbmr.270810.1002\/jbmr.2918","article-title":"Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research","volume":"31","author":"Adler","year":"2016","journal-title":"J. Bone Miner. Res."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.1007\/s00198-015-3459-5","article-title":"Multiple Clinical Vertebral Fractures Following Denosumab Discontinuation","volume":"27","author":"Anastasilakis","year":"2016","journal-title":"Osteoporos. Int."},{"key":"B3","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1007\/s00198-011-1627-9","article-title":"Ethnic Difference of Clinical Vertebral Fracture Risk","volume":"23","author":"Bow","year":"2012","journal-title":"Osteoporos. Int."},{"key":"B4","doi-asserted-by":"publisher","first-page":"281","DOI":"10.3969\/j.issn.1006-7108.2019.03.001","article-title":"Guidelines for the Diagnosis and Management of Primary Osteoporosis","volume":"25","year":"2017","journal-title":"Chin. J. Osteoporos."},{"key":"B5","doi-asserted-by":"publisher","first-page":"317","DOI":"10.3969\/j.issn.1674-2591.2019.04.001","article-title":"The Release of Results of an Epidemiological Survey in Osteoporosis in China and the \"Healthy Bones\" Campaign [J]","volume":"12","year":"2019","journal-title":"Chin. J. Osteoporosis&. Bone Miner Res."},{"key":"B6","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1002\/jbmr.3051","article-title":"Treatment Sequence Matters: Anabolic and Antiresorptive Therapy for Osteoporosis","volume":"32","author":"Cosman","year":"2017","journal-title":"J. Bone Miner Res."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta24290","article-title":"Denosumab, Raloxifene, Romosozumab and Teriparatide to Prevent Osteoporotic Fragility Fractures: a Systematic Review and Economic Evaluation","volume":"24","author":"Davis","year":"2020","journal-title":"Health Technol. Assess."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1595","DOI":"10.1210\/jc.2019-00221","article-title":"Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline","volume":"104","author":"Eastell","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e80890","DOI":"10.1371\/journal.pone.0080890","article-title":"Bisphosphonates for the Prevention and Treatment of Osteoporosis in Patients with Rheumatic Diseases: a Systematic Review and Meta-Analysis","volume":"8","author":"Feng","year":"2013","journal-title":"PLoS One"},{"key":"B10","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1016\/j.reuma.2018.11.002","article-title":"Multiple Vertebral Fractures Following Discontinuation of Denosumab Treatment: Ten Clinical Cases Report","volume":"16","author":"Fern\u00e1ndez Fern\u00e1ndez","year":"2020","journal-title":"Reumatol Clin. (Engl Ed."},{"key":"B11","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1007\/s10620-012-2465-0","article-title":"The Efficacy and Safety of Bisphosphonates for Osteoporosis or Osteopenia in Crohn's Disease: a Meta-Analysis","volume":"58","author":"Guo","year":"2013","journal-title":"Dig. Dis. Sci."},{"key":"B12","doi-asserted-by":"publisher","first-page":"380","DOI":"10.7326\/0003-4819-152-6-201003160-00008","article-title":"Meta-analysis: Excess Mortality after Hip Fracture Among Older Women and Men","volume":"152","author":"Haentjens","year":"2010","journal-title":"Ann. Intern. Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1007\/s00223-008-9117-6","article-title":"Utility Values Associated with Osteoporotic Fracture: a Systematic Review of the Literature","volume":"82","author":"Hiligsmann","year":"2008","journal-title":"Calcif Tissue Int."},{"key":"B14","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s40273-014-0231-1","article-title":"A Systematic Review of Cost-Effectiveness Analyses of Drugs for Postmenopausal Osteoporosis","volume":"33","author":"Hiligsmann","year":"2015","journal-title":"Pharmacoeconomics"},{"key":"B15","doi-asserted-by":"publisher","first-page":"895","DOI":"10.2165\/11539980-000000000-00000","article-title":"Cost Effectiveness of Denosumab Compared with Oral Bisphosphonates in the Treatment of post-menopausal Osteoporotic Women in Belgium","volume":"29","author":"Hiligsmann","year":"2011","journal-title":"Pharmacoeconomics"},{"key":"B16","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s00198-018-4744-x","article-title":"Recommendations for the Conduct of Economic Evaluations in Osteoporosis: Outcomes of an Experts' Consensus Meeting Organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the US branch of the International Osteoporosis Foundation","volume":"30","author":"Hiligsmann","year":"2019","journal-title":"Osteoporos. Int."},{"key":"B17","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1007\/s40273-013-0032-y10.1186\/1741-7015-11-80","article-title":"Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement","volume":"31","author":"Husereau","year":"2013","journal-title":"Pharmacoeconomics"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1359\/JBMR.050304","article-title":"Predictive Value of BMD for Hip and Other Fractures","volume":"20","author":"Johnell","year":"2005","journal-title":"J. Bone Miner Res."},{"key":"B19","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/s8756-3282(00)00381-1","article-title":"Risk of Hip Fracture According to the World Health Organization Criteria for Osteopenia and Osteoporosis","volume":"27","author":"Kanis","year":"2000","journal-title":"Bone"},{"key":"B20","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1016\/s8756-3282(03)00061-9","article-title":"The Components of Excess Mortality after Hip Fracture","volume":"32","author":"Kanis","year":"2003","journal-title":"Bone"},{"key":"B21","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1111\/joim.12586","article-title":"Excess Mortality after Hip Fracture in Elderly Persons from Europe and the USA: the CHANCES Project","volume":"281","author":"Katsoulis","year":"2017","journal-title":"J. Intern. Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/s40273-020-00965-9","article-title":"An Updated Systematic Review of Cost-Effectiveness Analyses of Drugs for Osteoporosis","volume":"39","author":"Li","year":"2021","journal-title":"Pharmacoeconomics"},{"key":"B23","volume-title":"China GuiDelines for Pharmacoeconomic Evaluations","author":"Liu","year":"2020"},{"key":"B24","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1007\/s11657-018-0429-5","article-title":"Incidence and Risk Factors of Medical Complications and Direct Medical Costs after Osteoporotic Fracture Among Patients in China","volume":"13","author":"Liu","year":"2018","journal-title":"Arch. Osteoporos."},{"key":"B25","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1007\/s00198-007-0499-5","article-title":"Epidemiology of Distal Forearm Fractures in Oslo, Norway","volume":"19","author":"Lofthus","year":"2008","journal-title":"Osteoporos. Int."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1254","DOI":"10.1136\/bmj.312.7041.1254","article-title":"Meta-analysis of How Well Measures of Bone mineral Density Predict Occurrence of Osteoporotic Fractures","volume":"312","author":"Marshall","year":"1996","journal-title":"BMJ"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1002\/jbmr.2193","article-title":"Predictors of Excess Mortality after Fracture: a Population-Based Cohort Study","volume":"29","author":"Melton","year":"2014","journal-title":"J. Bone Miner Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1007\/s11657-021-00891-z","article-title":"Cost-effectiveness of Sequential Daily Teriparatide\/weekly Alendronate Compared with Alendronate Monotherapy for Older Osteoporotic Women with Prior Vertebral Fracture in Japan","volume":"16","author":"Mori","year":"","journal-title":"Arch. Osteoporos."},{"key":"B29","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s11657-021-00956-z","article-title":"Cost-effectiveness of Zoledronic Acid Compared with Sequential Denosumab\/alendronate for Older Osteoporotic Women in Japan","volume":"16","author":"Mori","year":"","journal-title":"Arch. Osteoporos."},{"key":"B30","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1007\/s00198-016-3772-7","article-title":"Cost-effectiveness of Combined Oral Bisphosphonate Therapy and Falls Prevention Exercise for Fracture Prevention in the USA","volume":"28","author":"Mori","year":"","journal-title":"Osteoporos. Int."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1007\/s00198-017-3940-4","article-title":"Cost-effectiveness of Denosumab versus Oral Alendronate for Elderly Osteoporotic Women in Japan","volume":"28","author":"Mori","year":"","journal-title":"Osteoporos. Int."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e10233","DOI":"10.1002\/jbm4.10233","article-title":"Cost-Effectiveness of Sequential Teriparatide\/Alendronate versus Alendronate-Alone Strategies in High-Risk Osteoporotic Women in the US: Analyzing the Impact of Generic\/Biosimilar Teriparatide","volume":"3","author":"Mori","year":"2019","journal-title":"JBMR Plus"},{"key":"B33","article-title":"National Bureau of Statistics","year":"2020"},{"key":"B34","year":"2020"},{"key":"B35","article-title":"China Health Statistical Yearbook","year":"2020"},{"key":"B36","article-title":"National Medical Products Administration","year":"2020"},{"key":"B37","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.bone.2013.11.002","article-title":"Denosumab: a Cost-Effective Alternative for Older Men with Osteoporosis from a Swedish Payer Perspective","volume":"59","author":"Parthan","year":"2014","journal-title":"Bone"},{"key":"B38","doi-asserted-by":"publisher","first-page":"171","DOI":"10.5312\/wjo.v7.i3.171","article-title":"Major Osteoporotic Fragility Fractures: Risk Factor Updates and Societal Impact","volume":"7","author":"Pisani","year":"2016","journal-title":"World J. Orthop."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1917","DOI":"10.1007\/s00198-015-3458-6","article-title":"Rebound-associated Vertebral Fractures after Discontinuation of Denosumab-From Clinic and Biomechanics","volume":"27","author":"Popp","year":"2016","journal-title":"Osteoporos. Int."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1853","DOI":"10.1007\/s00198-014-2699-0","article-title":"The Economic burden of Fracture Patients with Osteoporosis in Western China","volume":"25","author":"Qu","year":"2014","journal-title":"Osteoporos. Int."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1001\/jama.2010.1360","article-title":"Atypical Fractures as a Potential Complication of Long-Term Bisphosphonate Therapy","volume":"304","author":"Sellmeyer","year":"2010","journal-title":"JAMA"},{"key":"B42","doi-asserted-by":"publisher","first-page":"2259","DOI":"10.1007\/s00198-016-3502-1","article-title":"Screening for Osteoporosis in Chinese post-menopausal Women: a Health Economic Modelling Study","volume":"27","author":"Si","year":"2016","journal-title":"Osteoporos. Int."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1987","DOI":"10.1007\/s00198-014-2636-2","article-title":"A Systematic Review and Meta-Analysis of Utility-Based Quality of Life for Osteoporosis-Related Conditions","volume":"25","author":"Si","year":"2014","journal-title":"Osteoporos. Int."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.1007\/s00198-015-3093-2","article-title":"Projection of Osteoporosis-Related Fractures and Costs in China: 2010-2050","volume":"26","author":"Si","year":"2015","journal-title":"Osteoporos. Int."},{"key":"B45","doi-asserted-by":"publisher","first-page":"627631","DOI":"10.1155\/2015\/627631","article-title":"Denosumab for Elderly Men with Osteoporosis: A Cost-Effectiveness Analysis from the US Payer Perspective","volume":"2015","author":"Silverman","year":"2015","journal-title":"J. Osteoporos."},{"key":"B46","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1007\/s00198-012-1984-z","article-title":"Risk of Refracture Associated with Compliance and Persistence with Bisphosphonate Therapy in Taiwan","volume":"24","author":"Soong","year":"2013","journal-title":"Osteoporos. Int."},{"key":"B47","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1007\/s11136-010-9762-x","article-title":"Population Health Status in China: EQ-5D Results, by Age, Sex and Socio-Economic Status, from the National Health Services Survey 2008","volume":"20","author":"Sun","year":"2011","journal-title":"Qual. Life Res."},{"key":"B48","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1007\/s00774-013-0484-3","article-title":"Hip Fractures in Hefei, China: the Hefei Osteoporosis Project","volume":"32","author":"Wang","year":"2014","journal-title":"J. Bone Miner Metab."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1651","DOI":"10.1007\/s00198-009-0925-y","article-title":"Osteoporosis in china","volume":"20","author":"Wang","year":"2009","journal-title":"Osteoporos. Int."},{"key":"B50","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1007\/s00198-009-0991-1","article-title":"Bisphosphonates and Osteoporotic Fractures: a Cross-Design Synthesis of Results Among Compliant\/persistent Postmenopausal Women in Clinical Practice versus Randomized Controlled Trials","volume":"21","author":"Wilkes","year":"2010","journal-title":"Osteoporos. Int."},{"key":"B51","doi-asserted-by":"publisher","first-page":"575893","DOI":"10.3389\/fphar.2020.575893","article-title":"Economic Evaluation of Oral Alendronate Therapy for Osteoporosis in Chinese Postmenopausal Women: The Impact of Medication Compliance and Persistence","volume":"11","author":"You","year":"2020","journal-title":"Front. Pharmacol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"456","DOI":"10.3389\/fphar.2020.00456","article-title":"Cost-Effectiveness of Zoledronic Acid versus Oral Alendronate for Postmenopausal Osteoporotic Women in China","volume":"11","author":"You","year":"2020","journal-title":"Front. Pharmacol."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2022.816248\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T05:37:20Z","timestamp":1647581840000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2022.816248\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,18]]},"references-count":52,"alternative-id":["10.3389\/fphar.2022.816248"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2022.816248","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,18]]},"article-number":"816248"}}