OBJECTIVES: Binosto^® (buffered soluble alendronate 70 mg) effervescent tablet represents an alternative option to traditional oral bisphosphonates for the management of osteoporosis, being associated to a lower frequency of gastro-intestinal adverse reactions and greater medication persistence. This study aimed to assess the cost-effectiveness of Binosto^® compared with relevant alternative treatments for postmenopausal osteoporotic women in Italy.

METHODS: A previously validated Markov microsimulation model was adjusted to the Italian healthcare setting to estimate the lifetime costs (expressed in €2019) per quality-adjusted life-years (QALY) of Binosto^® compared with generic alendronate, denosumab, zoledronic acid and no treatment. Pooled efficacy data for bisphosphonates derived from the most recent NICE network meta-analysis were used for bisphosphonate treatments and 1-year persistence of Binosto^® and alendronate was derived from a prospective observational study. Analyses were conducted for high-risk women 60-80 years of age with a bone mineral density (BMD) T-score ≤-3.0 or with existing vertebral fractures. One-way and probabilistic sensitivity analyses were performed to test the robustness of the model results.

RESULTS: In all simulated populations, Binosto^® was dominant (more QALYs, less costs) compared to denosumab. The cost per QALY gained of Binosto^® compared to generic alendronate and no treatment always fall below €20,000 per QALY gained. Zoledronic acid was associated with more QALY than Binosto^® but the cost per QALY gained of zoledronic acid compared with Binosto^® was always higher than €70,000 per QALY gained, meaning that zoledronic acid was not cost-effective. Probabilistic sensitivity analyses suggested that Binosto^® was the most cost-effective intervention for willingness to pay between €5,000 and €75,000 per QALY gained.

CONCLUSIONS: This study provides the first economic analysis of an alendronate effervescent tablet, suggesting that Binosto^® represents a cost-effective strategy compared with relevant alternative treatments for postmenopausal women with osteoporosis in Italy aged 60 years and over.