,

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:

, 15.06.2015.

: :. 03/2011

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, , . , . , , . . , , . , 30% 50% 65 , . . , (. ). : ( 45. ), ( 6 ), , , , . , , , (BMI), , , . , , , .

. . , , . 10-15 , , . , .

, . , . . , . , . . , . - 20%, 4. 2 . (wedge), (tassement en galette). Th11 L1 , Th8. 40% , , , 25% , . 20% .

(bone mineral density, BMD), . X , , .

BMD ( ) > 2,5 , , , (-). BMD - -1 -2,5. - -2,5, . - -2,5. , - -1,5.

. , . .

, , . , . .

. , , .

U.S. Food and Drug Administration / :

1)

(Selective Estrogen Receptor Modulators SERM, Raloxifen Evista) /

2)

(Teriparatide, Forteo)

(Fosamax), (Bonviva) (Actonel), .

, . , . , .

(Fosamax) , , . , .

(Bonviva) . , , .

( ). (Actonel) , . .

(Miacalcin, Calcimar, Fortical) , . . , , . .

5 , , . . Selective Estrogen Receptor Modulator (SERM) Raloxifene

Evista, . . .

/

. . / ( / ). , , , . .

, .

( Forteo) , . , . . . , , .

, . . . PubMed (MEDLINE). , . :

PUBMED steoporosis, cost, treatment. , . 58 , 10 . , 6 . , full-text . (AJMC.com, BMJ.com)

Cost-utility of denosumab for the treatment of postmenopausal osteoporosis in Spain [4]Josep Darb, Lisette Kaskens, Francesc Sorio Vilela, Mickael Lothgren

, , . , . . .. 8 : , , , , , , . , . (Spanish National Health System). FREEDOM (Fracture REduction Evaluation with Denosumab in Osteoporosis every 6 Months) . , , -. ( ) , . , (QALYs) . , , QALY. , 417.34, (ICER) 16,294, 4,895, 2,205 6,823, QALY. .

( )

417.34

162.82

283.80

156.00

595.54

The cost effectiveness of teriparatide as a firstline treatment for glucocorticoid-induced and postmenopausal osteoporosis patients in Sweden [5]Daniel R Murphy, Lee J Smolen, Timothy M Klein and Robert W Klein (PMO) (Glucocorticoid-induced osteoporosis (GIOP)).

. . , , . , . , (ICER) .

ICER ( ) 36,995 1 QALY, 19,371 1 QALY. 20,826 1 QALY 15,155 1 QALY. - , 50,000 QALY.

/ /

5,897 / QALY (historical + incident )18,701 / QALY (incident)19,371 / QALY36,995 1 / QALY

3,271 / QALY 7,330/ QALY15,155 / QALY20,826 / QALY

The cost utility of bisphosphonate treatment in established osteoporosis [6]C. P. Iglesias, D. J. Torgerson, A. Bearne, U. Bose , . , . (cost-utility analysis CUA), , (QALY). . MIMS (285 ). (30), (16). 3 1000 75 , 786 000 1000 . , 138 000 1000 , 16/1000 . 8625 QALY. 75 , , . , QALY, .

Impact of Generic Alendronate Cost on the Cost-Effectiveness of Osteoporosis Screening and Treatment [7]

Smita Nayak, Mark S. Roberts, Susan L. Greenspan

2008., . (cost-effectiveness) .

. -, 65 . (2010 US dollars), (QALY ) (ICER) () QALY. (lifetime time). cost-effectivness , TreeAge Pro Suite 2009. .

65. . $171 $343 $200. , 65 , ($200-800). $200 , . , , ( 10.6 QALY). $400 $800, , , ICER $714 $13.902 QALY.

, .

($) ICER ($/QALY)

20$343 ()

40$324 ()

60$305 ()

80$286 ()

100$266 ()

200$171 ()

400$712

600$7307

800$13.902

Cost-effective Osteoporosis Treatment Thresholds: The United States Perspective From the National Osteoporosis Foundation Guide Committee [8]

Anna N. A. Tosteson, L. Joseph Melton III, Bess Dawson-Hughes, Sanford Baim

, . . (Markov state-transition) TreeAge Pro . , / (. 50, 55,,85 ) ( ). . , , (QALY). , , ( , , , /). ($). $600, $900 $300, . ($49 ) $82 . $349 $949 .

, (willingness-to-pay) $60.000 QALY, ($50.000). 10 3%. ( , , ), .

ICER- $380,000 QALY 50 , 75 . QALY 2 , , . , 2 . 2,5% 4,7% 75 . 2,4% 4,9%.

Cost-effectiveness of strontium ranelate in the treatment of male osteoporosis [9] M. Hiligsmann & W. Ben Sedrine & O. Bruyre & J.-Y. Reginster

, , . . (2,010) (QALY) . ( ) , (SOTI, TROPOS ) . , 73, BMD - 2.5 .

, . , QLY- 49.798 25.584 . BMD 2.5 QLY- 45,000 25,000 . ; , , .

ITTPPS

()8.4509.3338.815

QALYs7,1977,2227,2396

ICER, /QALY/36.270 (34.363-38.177)8.230 (7.672-8.888)

ITT (intention to treat) ; PPS (perprotocol studies)

Therapies for Treatment of Osteoporosis in US Women: Cost-effectiveness and Budget Impact Considerations [10]Anna N. A. Tosteson, Russel T. Burge, Deborah A. Marshall, Robert Lindsay

, . , (QALY). 10 , , . : , , , (PTH) , . 65 . ($), 2005. . $799.76 , $771.36 , $835.64 , $6291.72 .

QALY-, () . , , , 75 . (ICER) $66,722 QALY- 65 . QALY ( 6.656, 6.647 6.624), (6.608 QALY) 6.580. , , , ., .

, , , . - . . , , . , . , . , . . . , . , , . A , 1,6 , 14 . , - . , ., 65 . , . , . , , . . . , , . . , , . , . , (, ) . . , , . . . , . , , , . , , . , . , , .

1) . , II, : :1403-1418, , 2003.

2) http://farmaceuti.com/tekstovi/farmakologija-2/preparati-za-lecenje-bolesti-kostiju/, 2015.

3) https://sites.google.com/site/ortopraxisdrradoicic/osteoporoza/leenje-osteoporoze, 2015. 4) Darb J, Kaskens L, Sorio Vilela F, Lothgren M. Cost-utility of denosumab for the treatment of postmenopausal osteoporosis in Spain. Clinicoecon Outcomes Res. 2015;7:105-17.

5) Murphy DR, Smolen LJ, Klein TM, Klein RW. The cost effectiveness ofteriparatide as a first-line treatment for glucocorticoid-induced andpostmenopausal osteoporosis patients in Sweden. BMC Musculoskelet Disord. 2012;13:213.

6) Iglesias C, Torgerson DJ, Bearne A, Bose U. The cost utility ofbisphosphonate treatment in established osteoporosis. QJM. 2002;95(5):305-11.

7) Nayak S, Roberts MS, Greenspan SL. Impact of generic alendronate cost on the cost-effectiveness of osteoporosis screening and treatment. PLoS One.2012;7(3):e32879.

8) Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, Baim S; National Osteoporosis Foundation Guide Committee. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int.2008;19(4):437-47.

9) Hiligsmann M, Ben Sedrine W, Bruyre O, Reginster JY. Cost-effectiveness of strontium ranelate in the treatment of male osteoporosis. Osteoporos Int. 2013;24(8):2291-300.

10) Tosteson AN, Burge RT, Marshall DA, Lindsay R. Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations. Am J Manag Care. 2008 Sep;14(9):605-15.

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