Introduction

The National Institute for Health and Care Excellence (NICE) has recently recommended abaloparatide for treating osteoporosis in postmenopausal women, trans men, and non-binary individuals at very high risk of fracture. This guidance is essential for healthcare in the elderly, aiming to improve bone health and reduce fracture risk.

Understanding Osteoporosis and Its Impact

Osteoporosis is a progressive skeletal disorder characterised by low bone density, leading to an increased risk of fractures. These fractures can be painful and significantly affect a person’s independence and quality of life. According to patient experts, the fear of fractures often leads to anxiety and withdrawal from daily activities. Consequently, managing osteoporosis effectively is crucial for enhancing the well-being of the elderly.

Current Treatment Landscape

Traditional treatments for osteoporosis include bisphosphonates like alendronic acid, and anabolic treatments such as teriparatide and romosozumab. These treatments aim to improve bone strength and reduce fracture risk. However, they have limitations, including side effects like hypercalcaemia and osteonecrosis, which can affect adherence. For instance, teriparatide requires refrigeration, posing a challenge for those who travel frequently.

The Role of Abaloparatide

Abaloparatide is a newer anabolic treatment option. It has shown to be effective in reducing the risk of vertebral fractures by 88% compared to placebo, according to the ACTIVE trial. This treatment is recommended for those at very high risk of fractures, defined by a 60% higher fracture probability than the intervention threshold. Unlike teriparatide, abaloparatide does not require refrigeration after the first use, making it more convenient for patients.

Clinical and Economic Considerations

Clinical trials and real-world evidence support the efficacy of abaloparatide. The ACTIVE trial demonstrated a significant reduction in fracture risk, while a real-world study showed that abaloparatide was statistically non-inferior to teriparatide for non-vertebral fractures. Economically, abaloparatide’s cost-effectiveness falls within the acceptable range for NHS resources, with a list price of £294.54 per pre-filled pen.

Cost Effectiveness Analysis

NICE’s evaluation of abaloparatide’s cost-effectiveness considered incremental cost-effectiveness ratios (ICERs) and quality-adjusted life years (QALYs). The analysis highlighted that incremental QALYs were small, causing ICERs to fluctuate significantly. Therefore, net health benefit was used as a more stable measure. Abaloparatide’s net health benefit, at a threshold value of £20,000 per QALY gained, was compared with that of romosozumab and teriparatide. This approach confirmed that abaloparatide is a cost-effective option for the NHS, providing a viable and economically sound treatment for those at very high risk of fractures.

Conclusion

NICE’s recommendation of abaloparatide offers a promising alternative for managing osteoporosis in elderly patients at very high risk of fractures. This guidance not only addresses the clinical needs but also considers the economic implications, ensuring a balanced approach to healthcare delivery.