Romosozumab (Evenity)

CADTH recommends that Evenity should be reimbursed by public drug plans for the treatment of osteoporosis in postmenopausal women if certain conditions are met. Evenity should only be covered to treat postmenopausal women with a history of osteoporosis-related fracture and who are likely to have such a fracture in the future and who have never received previous medications for osteoporosis. Evenity should only be reimbursed if the cost is reduced and if it is not prescribed concurrently with other osteoporosis medications, except for calcium and/or vitamin D.

Economic Burden of Osteoporosis-Related Fractures in the US Medicare Population

Background Osteoporosis-related fractures are an important public health burden. Objective To examine health care costs in Medicare patients with an osteoporosis-related fracture. Methods Medicare fee-for-service members with an osteoporosis-related fracture between January 1, 2010, to September 30, 2014 were included. A nonfracture comparator group was selected by propensity score matching. Generalized linear models using a gamma distribution were used to compare costs between fracture and nonfracture cohorts. Results A total of 885 676 Medicare beneficiaries had fracture(s) and met inclusion criteria. Average age was 80.5 (±8.4) years; 91% were White, and 94% female. Mean all-cause costs were greater in the fracture vs nonfracture cohort ($47 163.25 vs $16 034.61) overall and for men ($52 273.79 vs $17 352.68). The highest mean costs were for skilled nursing facility ($29 216), inpatient costs ($24 190.19), and hospice care ($20 996.83). The highest incremental costs versus the nonfracture cohort were for hip ($71 057.83 vs $16 807.74), spine ($37 543.87 vs $16 860.49), and radius/ulna ($24 505.27 vs $14 673.86). Total medical and pharmacy costs for patients who experienced a second fracture were higher compared with those who did not ($78 137.59 vs $44 467.47). Proportionally more patients in the fracture versus nonfracture cohort died (18% vs 9.3%), with higher death rates among men (20% vs 11%). Conclusion and Relevance The current findings suggest a significant economic burden associated with fractures. Early identification and treatment of patients at high risk for fractures is of paramount importance for secondary prevention and reduced mortality.

Posthospital Discharge Medical Care Costs and Family Burden Associated with Osteoporotic Fracture Patients in China from 2011 to 2013

Objectives. This study collected and evaluated data on the costs of outpatient medical care and family burden associated with osteoporosis-related fracture rehabilitation following hospital discharge in China.Materials and Methods. Data were collected using a patient questionnaire from osteoporosis-related fracture patients (N= 123) who aged 50 years and older who were discharged between January 2011 and January 2013 from 3 large hospitals in China. The survey captured posthospital discharge direct medical costs, indirect medical costs, lost work time for caregivers, and patient ambulatory status.Results. Hip fracture was the most frequent fracture site (62.6%), followed by vertebral fracture (34.2%). The mean direct medical care costs per patient totaled 3,910¥, while mean indirect medical costs totaled 743¥. Lost work time for unpaid family caregivers was 16.4 days, resulting in an average lost income of 3,233¥. The average posthospital direct medical cost, indirect medical cost, and caregiver lost income associated with a fracture patient totaled 7,886¥. Patients’ ambulatory status was negatively impacted following fracture.Conclusions. Significant time and cost of care are placed on patients and caregivers during rehabilitation after discharge for osteoporotic fracture. It is important to evaluate the role and responsibility for creating the growing and inequitable burden placed on patients and caregivers following osteoporotic fracture.

Screening and treatment of osteoporosis in breast cancer survivors treated with aromatase inhibitors: Gap between the national guidelines and real-world practice.

113 Background: Breast cancer survivors who are on adjuvant therapy with Aromatase Inhibitors (AIs) are known to have an increased risk of osteoporosis. AIs reduce estrogen levels and cause accelerated loss of bone density. Being at high risk for osteoporosis, these patients should be screened and followed up for bone mineral density (BMD) with dual energy X-ray absorptiometry (DEXA) scan as directed by national guidelines. The purpose of this study was to evaluate if this patient population is adequately screened and intervened appropriately. Methods: We conducted a two center, retrospective, clinical observational study at Guthrie cancer center at Sayre and Corning using Guthrie tumor registry. Patients with diagnosis of invasive breast cancer and on adjuvant therapy with AIs were included in this study. Patients with metastatic bone disease and those who were receiving palliative care were excluded. Results: During the study period, a total of 703 breast cancer patients were identified and 292 patients were on AIs. Baseline DXA scan for BMD was done in 54 % (158 out of 292) patients. Of these, 22% (n=35) had osteoporosis and 43% (n=68) had osteopenia. FRAX (Fracture risk assessment tool) score using WHO algorithm was calculated in patients with osteopenia. After calculating FRAX score, 28 of 68 patients were found to have ≥3% ten year probability (TYP) of a hip fracture or ≥20% TYP of a major osteoporosis-related fracture. These 28 patients with osteopenia and 35 patients (total n=64) with osteoporosis were required to be on treatment as per guideline recommendations. Only 23% (15 of 64) patients recieved treatment. Two year follow up on patients taking AI was done (n=292) and 46% (n= 137) patients had repeat BMD. Of the patients who had known osteoporosis and TYP of hip fracture ≥ 3% or a TYP of a major osteoporosis-related fracture ≥ 20%, only 54% (35 of 64) had follow up BMD. Conclusions: This study highlights the fact that osteoporosis is an under-detected and inadequately treated condition in breast cancer survivors who are on AIs. There is still a huge gap between guidelines and real world practice on prevention and treatment of osteoporosis this patient population.