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Cost-Effectiveness of Denosumab for Post-Menopausal Osteoporosis in South Korea
Korean J Clin Pharm 2018;28(2):131-137
Published online June 30, 2018
© 2018 Korean College of Clinical Pharmacy.

Green Bae1 and Hye-Young Kwon2*

1College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea
2Division of Biology & Public Health, Mokwon University, Daejeon 35349, Republic of Korea
Correspondence to: * Hye-Young Kwon, Division of Biology & Public Health, Mokwon University, 88 Doanbuk-ro, Seo-gu, Daejeon 35349, Republic of Korea
Tel: +82-42-829-7595, Fax: +82-42-829-7590 E-mail:
Received February 20, 2018; Revised June 16, 2018; Accepted June 16, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: In South Korea, 22.3% of women ≥50 years of age and 37% of women ≥70 years of age visit the doctor to obtain treatment for osteoporosis. According to the analysis of the National Health Insurance Services claim data between 2008 and 2012, the number and incidence of hip and vertebral fractures increased during the same period. Denosumab, a newly marketed medicine in Korea, is the first RANK inhibitor.
Methods: A cost-utility analysis was conducted from a societal perspective to prove the superiority of denosumab to alendronate. A Markov cohort model was used to investigate the cost-effectiveness of denosumab. A 6-month cycle length was used in the model, and all patients were individually followed up through the model, from their age at treatment initiation to their time of death or until 100 years of age. The model consisted of eight health states: well; hip fracture; vertebral fracture; wrist fracture; other osteoporotic fracture; post-hip fracture; post-vertebral fracture; and dead. All patients began in the well-health state. In this model, 5% discounted rate, two-year maximum offset time, and persistence were adopted.
Results: The total lifetime costs for alendronate and denosumab were USD 5,587 and USD 6,534, respectively. The incremental cost-effectiveness ratio (ICER) for denosumab versus alendronate was USD 20,600/QALY. Given the ICER threshold in Korea, the results indicated that denosumab was remarkably superior to alendronate.
Conclusion: Denosumab is a cost-effective alternative to the oral anti-osteoporotic treatment, alendronate, in South Korea.
Keywords : Osteoporosis, cost-effectiveness analysis, pharmacoeconomics, denosumab

June 2018, 28 (2)
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