Ibandronate vs. Alendronate for Osteoporosis – Best Study Guides(2022)

Cost-Effectiveness of Ibandronate vs. Alendronate used in treatment of osteoporosis, in a specialized clinic in Tirana.

Dr. Mirela Miraçi¹;

Msc.Arlinda Demeti²;

Prof.as Zamira Ylli³;

Prof.Mira Ziçishti³;

Prof.As Suela Kelliçi¹

1. Faculty of Pharmacy, University of Medicine, Tirana.
2. Bioparafarmacia Franceze
3. Neostyle Clinic

Abstract:

Osteoporosis is a systemic skeletal disease with a high prevalence. Biphosphonates are medicaments which are chosen for their efficacy in reducing fracture incidence, increasing bone density and improving bone microarchitecture. The aim of the study is to evaluate the effectiveness of the drugs (ibandronate and alendronate) used in osteoporosis treatment, in post-menopausal women over the age of 50 years at a specialized clinic in Tirana; to calculate the annual cost of treatment of osteoporosis and to perform a cost effectiveness analyze.

Methods: Retrospective. The patients were all female, in menopause or post menopause, with T-score -1 to -6, treated with alendronate or ibandronate. The effectiveness is calculated as the average percentage of change in bone mineral density (av. % of change in BMD) of year 2011 vs. 2010 baseline. The annual cost of the treatment of osteoporosis according to the protocols and the cost of the examination with DXA scan (dual x-ray absorptiometry) were calculated. Finally a comparison of the cost-effectiveness was performed.

Conclusion: Patients with osteoporosis treated with Ibandronate, at our clinic in Tirana, have an average change from baseline higher compared with patients treated with Alendronate, with statistically significant difference between them (Man Whitney U = 66.0, p < 0.01).

The annual cost of the disease when treated with ibandronate is 1.3 times higher than the annual cost of treatment with alendronate. Ibandronate is more cost – effective than all other alendronate .

Introduction: Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures⁽¹⁾

The World Health Organization defines osteoporosis as bone density 2.5 standard deviations (SDs) below the mean for young white adult women at lumbar spine, femoral neck or forearm.⁽²⁾

Osteoporosis leads to nearly 9million fractures each year worldwide and over 300,000patients with fragility fractures are registered in UK hospitals each year (British Orthopaedic Association, 2007).⁽³⁾

Direct medical costs due to fragility fractures in UK healthcare economy were estimated at £1.8billion in 2000, with the potential to increase to £2.2billion by 2025 and the major part of these costs were related to hip fracture care.⁽⁵⁾

The annual cost of osteoporosis and fractures in the US elderly was estimated at $16 billion⁽⁶⁾

Osteoporosis is diagnosed by a T-score, which is the number of standard deviation (SD) that patient’s bone mineral density (BMD), measured using dualX-ray absorptiometry, differs from the mean BMD of 30-years old premenopausal women. Patients with T-score of between -1 and -2.5 SD are said to have osteoporosis.^7,8

Biphosphonates are medicaments which are chosen for their efficacy in reducing fracture incidence, increasing bone density and improving bone microarchitecture.^9-15

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Methods: Retrospective. The patients were all female, in menopause or post menopause, 50 years old or elder, with T-score -1 to -6, diagnosed for the 1rst time in 2010 (the 1rst BMD measurement), who have received treatment (alendronate or ibandronate) for 12 months and in 2011 have performed a 2nd BMD measurement.

The effectiveness is calculated as the average percentage of change in bone mineral density (av.% of change in BMD) of year 2011 vs. 2010 baseline. It was calculated the annual cost of the treatment of osteoporosis according to the protocols: with once monthly 150 mg oral ibandronate plus supplements (calcium, vitamine D) and once weekly 70 mg alendronate (4 times per month) plus supplements (calcium, vitamine D). There are also included other direct costs such as the examination with DXA scan (dual x-ray absorptiometry) to determine the diagnosis and the medical visits. Finally a comparison of the cost-effectiveness will be performed.

Statistical Analysis

Data were analyzed with SPSS 20 statistical package. It is used the non-parametric Man Whitney U test to compare the continuous variables, Fisher Exact test was used to compare proportions between variables and the the Odds Ratio OR for assessing the association between variables. Point estimations are accompanied with interval estimation by 95 % CI. For continuous variables is presented the average, the standard deviation and the minimum and maximum values. The level of statistical significance is defined at ? ? 005.

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Results of the study

In our study were included 70 patients who fulfill the inclusion criteria. 24 patients were treated with once monthly 150 mg oral ibandronate and 46 patients with once weekly 70 mg alendronate. There were not case of fracture among our patients.

Table 1 compares the frequency of pathologies (osteopenia and osteoporosis) in two groups of patients treated with alendronat or ibandronat.

OR= 1.3 95%CI 0.5 – 4.2 p=0.4

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Number of patients treated with alendronate is 1.3 times higher than the number of patients treated with ibandronate in the case of osteoporosis. (OR = 1.3, 95% CI 0.5-4.2, p = 0.4).

Chart 1

Calculation of efficiency

We have to calculate the average percentage of change of BMD (2011) to baseline (2010):

Table2. In the group of Alandronate

(N=46)

we have found this data:

*Fisher exact test p=0.3

There are 46 patients treated with alendronate. 18 ( 39.1 %) (95% ; CI 29.7 – 52.1) of them suffer from osteoporosis and 28 ( 60.9 % ) (95 % CI 47.8 – 74.2) from osteopenia, with no statistically significant difference between them, p = 0.9

The change from baseline for Alendronate group

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The change from baseline is calculated:

Table 3

Patients with osteopenia have an average change from baseline higher compared with patients with osteoporosis, no statistically significant difference between them (Man Whitney U = 316.0, p = 0.2).

Table 4. In the group of Ibandronate (N= 24)
we have find this data: