choice of treatments of osteoporosis in vietnam le anh thu, md, phd department of rheumatology cho...
TRANSCRIPT
CHOICE OF TREATMENTS OF
OSTEOPOROSIS IN VIETNAM
Le Anh Thu, MD, PhD Department of Rheumatology
Cho Ray Hospital, Vietnam
CONTENTS
Magnitude of the problemCurrent guidelinesTherapies availableEconomic considerationSummary
Osteoporosis and Fracture
Prevalence of osteoporosis in Vietnam (postmenopausal women): 23% or 2.5 million (Huong Nguyen, et al, Osteoporosis Int 2008)
Lifetime risk of fractures in Vietnam: unknown
Lifetime risk of fractures in Caucasian women: 44% (Nguyen ND, et al, JBMR 2007)
Prevalence of Osteoporosis
Country Prevalence of osteoporosis (T-scores < -2.5)
Vietnam 23.1
Thailand 29.5
Indonesia ~15.0
Hong Kong 49.6
China 10.1
Japan 17.0
South Korea ~10.0
Australia 21.4
U.S.A (White) 20.0
Incidence of Hip Fractures
0
500
1000
1500
2000
2500
3000
3500
50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+Inci
den
ce p
er 1
00,0
00 p
erso
ns
Nguồn: EMC Lau, et al. Osteoporosis Int 2001;12:239-43
USA
Hong Kong
Singapore
Thailand
80000
85000
90000
95000
100000
105000
110000
Year
Po
pu
lati
on
(1
00
0) 104
5
6
7
8
9
10
11
12
Year
Po
pu
lati
on
ag
e 6
5 +
Population Population age + 65
The Aging of Population
– Population: 84 million (2008) -- 104 million (2030)– Population over 65: 7% (2008) -- 11% (2030)
Projected Number of Fractures in Vietnam 2006-2030
85,522
106,075
66,88060,108
102,553
131,138
162,654
92,169
0
30,000
60,000
90,000
120,000
150,000
180,000
2006 2010 2020 2030 Year
Nu
mb
er
Men Women
Projected Number of Hip Fractures in Vietnam 2006-2030
6,296 7,005
11,1108,957
16,773
29,600
23,865
18,663
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
2006 2010 2020 2030 Year
Nu
mb
er
Men Women
Treatment Guidelines – Asian Osteoporosis Foundation
5.39
44.97
40.1838.41
36.55
76.04
35.99
29.32
17.69
10.958.19 7.87
5.494.73 3.91 2.99
1.42 0.88 0.84 0.69 0.5 0.48 0.48
0
10
20
30
40
50
60
70
80
Source : World Bank Development Indicators 2007
Vietnam (~700 USD)
Per Capita GDP (2007)
• Fosamax• Rocaltrol• Miacalcic spray (200 IU)• Miacalcic spray (50 IU)• Evista• Glakay• BRIOZCAL (calcium)
• Strontium Ranelate (in near future)• Zoledronate (in near future)
Therapies Available in Vietnam
Osteoporosis Therapies and GDP
Formulation Company
Price per tab/cap (in
USD)
Daily cost
(USD)
Yearly cost (USD)/
average income
FOSAMAX Tab 70mg MSD 5.36
0.77 280
(40%)
ROCALTROL Tab 0.25mcg ROCHE 0.21
0.43157
(22.4%)
MIACALCIC Spray 200 IU Nasal spray NOVARTIS 71.22
5.09
1,825(260%)
MIACALCIC Inj.- 50IU Ampoules NOVARTIS 4.41
8.82
3,220(460%)
EVISTA Tab 60mg ELI LILY 0.875 0.875320
(45.7%)
GLAKAY Capsule 15mg EISAI 0.36 1.07390
(55.7%)
BRIOZCALTab 500mg +
800 UI D3 BHC 0.17 0.34124
(17.8%)
MILK 500ML 0.62 228
(32.5%)
• Public health insurance system covers <50% of treatment costs
• Osteoporosis treatment:
Health insurance covers Alendronate (only in tertiary hospitals, from 7/2008)
Health Insurance
Cost-effectiveness of Treatment
2.5 million osteoporosis
Number of hip fractures: 25,000(incidence 1%)
Cost of Rx:60 million USD(2.500/case)
Number of hip fractures: 12,500
(RR=0.5)
TreatmentCost: 1.01 billion(404 USD/year)
Cost to reduce one hip fracture case: 80.800 USD
Number Needed to Treat (NNT) and Baseline Risk
0.05 0.10 0.15 0.20 0.25 0.30
10
20
30
40
50
60
70
80
Incidence of vertebral fracture in placebo group
Nu
mb
er
ne
ed
ed
to tr
ea
t (N
NT
)
Data were obtained from published RCTs in osteoporosis and antifracture efficacy
Optimal Strategy for Treatment and Prevention
• Treatment
Identify individuals at high-risk of fracture;
Select therapies that are efficacious and safe
• Prevention
Increase community awareness and knowledge of osteoporosis
Encouragement of healthy lifestyles
Idenfication of High-risk Individuals
• Use of risk factors
Age, low BMD, prior fracture, corticosteroid use, fall, cigarette smoking, low body weight, etc.
• Use current algorithms of absolute riskFRAX model
Garvan Institute’s model
Selection of Efficacious and Safe Therapies
• Evidence-based medicine
Meta-analysis of RCTs
RCT (randomized controlled clinical trials)
Well designed prospective studies
• Cost considerationAffordable
Challenges in Treatment and Management of Osteoporosis in
Vietnam
• Osteoporosis and fracture are increasingly prevalent in Vietnam.
• Effective therapies are available
• Per capita GDP is low. Cost of treatment could take up to 40% of per capita GDP.
• However, treatment seems worthwhile for high-risk individuals.
Acknowledgments
On behalf of the Osteoporosis Society of Ho Chi Minh City, I would like to acknowledge the support and help of:
• Bridge Healthcare, Eisai, MSD (Vietnam), Norvatis, Servier….
• Prof Tuan Nguyen of the Garvan Institute of Medical Research for helpful suggestions and critical comments
• All members in Organization Committee
World Osteoporosis Day in HoChiMinh City on October 20 each year.
Promotion for bone health in community
Some preliminary Some preliminary effortsefforts
Established Osteoporosis Association of HCM City
12 August 2006
Strong Bone Asian in Pattaya, Thailand
September 2007