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The article describes the adaptation of a model to estimate the burden of postmenopausal osteoporosis in women aged 50 years and over in Italy between 2010 and 2020. For this purpose, a validated postmenopausal osteoporosis disease model developed for Sweden was adapted to Italy. For each year of the study, the ‘incident cohort’ (women experiencing a first osteoporotic fracture) was identified and run through a Markov model using 1-year cycles until 2020. Health states were based on the number of fractures and deaths. Fracture by site (hip, clinical vertebral, non-hip non-vertebral) was tracked for each health state. Transition probabilities reflected fracture site-specific risk of death and subsequent fractures. Model inputs specific to Italy included population size and life tables from 1970 to 2020, incidence of hip fracture and BMD by age in the general population (mean and standard deviation). The model estimated that the number of postmenopausal osteoporotic women would increase from 3.3 million to 3.7 million between 2010 and 2020 (+14.3 %). Assuming unchanged incidence rates by age group over time, the model predicted the overall number of osteoporotic fractures to increase from 285.0 to 335.8 thousand fractures between 2010 and 2020 (+17.8 %). The estimated expected increases in hip, vertebral and non-hip non-vertebral fractures were 22.3, 17.2 and 16.3 %, respectively. Due to demographic changes, the burden of fractures is expected to increase markedly by 2020.

UNLABELLED: This article describes the adaptation of a model estimating the burden of postmenopausal osteoporosis (PMO) to the UK. PURPOSE: The purpose of this study was to estimate the present and future epidemiology of PMO in the UK. METHODS: For each year of the study, the 'incident cohort' (women experiencing a first osteoporotic fracture) was identified and run through a Markov model using 1-year cycles until 2020. Health states were based on the number of fractures and death. Fracture by site was tracked for each health state. Transition probabilities reflected fracture site-specific risk of death and subsequent fractures. RESULTS: Assuming that the rate of incident fractures by age is constant over time, the model estimated the total number of PMO fractures at 224,219 in 2010, including 51,927 hip and 30,994 clinical vertebral fractures. These estimates were predicted to increase by 17.2%, 16.6% and 17.9%, respectively, by 2020. The number of postmenopausal women living with osteoporosis was predicted to increase from 1.8 million in 2010 to 2.1 million in 2020 (+16.5%). A sensitivity analysis demonstrated that the estimated number of fractures is most sensitive to the assumption made on the trends in the rate of incidence. CONCLUSION: The PMO disease model, first developed for Sweden, was adapted to the UK. Due to demographic changes, the burden of osteoporosis is expected to increase by almost a fifth by 2020. Due to the lack of country-specific data, these results rely on several assumptions regarding the incidence of non-hip fractures, trends in BMD and rate of incidence over time.

Background The introduction of biologic therapies has dramatically changed the management of psoriatic arthritis (PsA), however, these therapies are more expensive than previous treatments. To our knowledge, there is little information about the economic impact of biologic use over a long-term period. Objectives The study aimed to estimate long-term costs of biologics in the treatment of PsA patients in the United States. Methods We developed a 10-year Markov model describing the treatment pathway of patients with PsA who had failed prior oral DMARD therapy, using monthly cycles. Clinical efficacy data were obtained from published pivotal study results and literature. Costs, resource utilisation and treatment pathways were obtained from the literature and expert opinion. Patients transitioned through two lines of biologics (etanercept, infliximab, golimumab or adalimumab as first or second line) followed by best supportive care. Response to therapy was defined as the probability of PsARC response at the end of the trial period. Patients transitioned to the next line of therapy in case of non-response or discontinuation due to other causes (a short-term annual drop-out rate of 32% and a long-term rate of 16.5% were assumed). All-cause death was included and adjusted to reflect the increased mortality associated with PsA. Treatment and administration, monitoring, and hospitalisation costs were included. An annual discount rate of 3% was used. Probabilistic sensitivity analysis was conducted on key model parameters. For each first-line biologic option, average results across second-line biologic therapies were reported. Results From a third-party payer’s perspective, the estimated 10-year cumulative direct costs per patient were $214,642 (95% CrI: $214,171; $221,074) with etanercept as first-line biologic therapy, $203,140 (95% CrI: 202,632; $208,398) with infliximab, $218,703 (95% CrI: $217,992; $224,255) with golimumab and $208,840 (95% CrI: $208,192; $215,014) with adalimumab. Across scenarios, drug costs represented between 89.4% and 91.1% of total costs, monitoring costs between 4.5% and 6.3%, and hospitalisation costs between 4.3% and 4.9%. Conclusions Biologic therapies represent a significant cost burden to payers over a 10-year period. First line therapy with infliximab produced the lowest overall costs. Disclosure of Interest S. Cure Consultant for: Celgene Corporation, Employee of: OptumInsight, H. Cawston Consultant for: Celgene Corporation, Employee of: OptumInsight, V. Damera Consultant for: Celgene Corporation, Employee of: OptumInsight, T. Tencer Employee of: Celgene Corporation, F. Zhang Employee of: Celgene Corporation, S. Feldman Grant/research support from: Celgene, Abbott, Amgen, Janssen, Consultant for: Celgene, Abbott, Amgen, Janssen