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Denosumab versus Zoledronic Acid for Adults with Osteoporosis: A Review of Cost-Effectiveness

Last updated: December 12, 2016
Project Number: RC0829-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report


  1. What is the cost-effectiveness of denosumab versus zoledronic acid in patients with osteoporosis?

Key Message

Two studies were identified that evaluated the cost-effectiveness of denosumab for the treatment of elderly men with osteoporosis, from a payer perspective in the United States or Sweden. Both studies found that subcutaneous denosumab 60 mg administered once every six months was associated with lower-costs and higher health benefits than intravenous zoledronic acid administered once a year, even when the price of zoledronic acid was lowered to consider the impact of generic drug pricing. Therefore, the authors concluded that denosumab was a cost-effective option for the treatment of elderly men with osteoporosis in the United States and Sweden. However, treatment efficacy inputs for the model were derived from fracture risk data in women. This decision was based on the similar post-treatment bone mineral density changes in men and women but direct evidence of fracture risk reduction in men was not available; therefore, results should be interpreted with caution. Both included studies were authored by individuals affiliated with the manufacturer of subcutaneous denosumab 60 mg; the potential impact of industry involvement on the findings is unclear. No evidence regarding the cost-effectiveness of denosumab versus zoledronic acid was identified for alternative populations (e.g., postmenopausal women or patients with non-metastatic cancer) or in a Canadian setting.