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Cost Effectiveness of Nasal Calcitonin in Postmenopausal Women

Use of Cochrane Collaboration Methods for Meta-Analysis Within Economic Evaluation

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Abstract

Objective: To assess the cost effectiveness of nasal calcitonin (Miacalcin®) compared with no therapy, alendronate or etidronate in the treatment of postmenopausal women with previous osteoporotic fracture.

Design and setting: Meta-analysis followed by economic analysis.

Perspective: A Canadian provincial Ministry of Health.

Methods: The meta-analysis of randomised controlled clinical trials was based on the recommendations of the Cochrane Collaboration. Economic analysis was conducted within a Markov model using probabilities and costs derived from Canadian sources.

Results: The meta-analysis found evidence of the positive effect of both nasal calcitonin and alendronate in reducing the risks of hip, wrist and vertebral fractures in postmenopausal women. However, there was a lack of evidence of the effect of etidronate on hip and wrist fractures. For a 65-year-old woman, with 5 years’ therapy, the incremental cost per quality-adjusted life-year (QALY) gained for nasal calcitonin was 46 500 Canadian dollars ($Can) compared with no therapy and $Can32 600 compared with etidronate (1998 values). Comparison with alendronate was highly sensitive to the inclusion of one specific trial.

Conclusions: Given the results of the analysis, based on current evidence, nasal calcitonin can be considered at themargins of being cost effectiv ewhen compared with no therapy. Compared with active therapy, nasal calcitonin can be considered more cost effective than etidronate, but its cost effectiveness versus alendronate is inconclusive.

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Acknowledgements

The study was funded by Novartis Canada Inc. However, the investigators had complete independence regarding methodological considerations and analysis at all stages of the study. We are grateful to Dr Jonathan Adachi, Dr David Hanley and Dr Alexandra Papaioannou for their comments on the detailed report of the study, and for the comments of the two anonymous referees.

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Authors and Affiliations

  1. Clinical Epidemiology Unit, Loeb Health Research Institute, Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9

    Douglas Coyle, Ann Cranney, Vivian Welch & Peter Tugwell

  2. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Douglas Coyle, Ann Cranney & Peter Tugwell

  3. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada

    Douglas Coyle & Peter Tugwell

  4. Health Priorities Research Group, University of California, Irvine, California, USA

    Karen M. Lee

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  1. Douglas Coyle
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Correspondence to Douglas Coyle.

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Coyle, D., Cranney, A., Lee, K.M. et al. Cost Effectiveness of Nasal Calcitonin in Postmenopausal Women. Pharmacoeconomics 19, 565–575 (2001). https://doi.org/10.2165/00019053-200119050-00010

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