References of "Hiligsmann, Mickaël"
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See detailEvaluation économique de la prise en charge de l'ostéoporose
Hiligsmann, Mickaël ULg

Doctoral thesis (2010)

Health economic evaluation is a method for evaluating the value for money of medical technologies by comparing alternative options in terms of their costs and consequences. This method is frequently used ... [more ▼]

Health economic evaluation is a method for evaluating the value for money of medical technologies by comparing alternative options in terms of their costs and consequences. This method is frequently used to inform decision makers about how to allocate scarce resources. Economic evaluation has become increasingly important nowadays, with the increasing health care expenditures, the rapid introduction of new medical technologies, and the extending role of economic evaluations in health care decision making. Osteoporosis becomes an increasingly major health problem around the world. It is a disease characterized by low bone mass with microarchitectural disruption and increased skeletal fragility, leading to increased fracture risk. Osteoporotic fractures result in significant morbidity and mortality, and impose a huge financial burden on health care systems. Financial resources are used to prevent, diagnose and treat osteoporosis. These resources must be allocated in an efficient manner. The general purpose of this thesis is therefore to contribute to the economic evaluation of osteoporosis management. More specifically, this thesis is divided into four parts. The first part is devoted to the development and the validation of a new Markov microsimulation model. This modelling approach accurately encompasses the complexity of osteoporosis, increasing the reliability of the results. The second part estimates the cost-effectiveness of osteoporosis screening strategies and provides recommendations for their implementation. The third part estimates the cost-effectiveness of new anti-osteoporotic therapies (strontium ranelate and denosumab). It is important to assess whether new drugs represent a good value for money compared to the relevant alternatives. Finally, the last part of the thesis investigates the clinical and economic implications of non-adherence to osteoporosis medications. This thesis provides new information on the cost-effectiveness of osteoporosis management, which may be useful to inform decisions makers about resources allocation for patients with osteoporosis. The results may also be used to raise awareness among public health authorities, the medical profession and the general population regarding the burden of osteoporosis, the importance of screening and adequate follow-up, as well as to the role of economic evaluation in health care decision making. [less ▲]

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See detailOral calcitonin in the management of osteoarthritis: hope or fantasy ?
Reginster, Jean-Yves ULg; Neuprez, Audrey ULg; Hiligsmann, Mickaël ULg et al

in International Journal of Clinical Rheumatology (2010), 5(1), 53-58

In the mid-1980s, calcitonin was used as a potential treatment for postmenopausal osteoporosis. However, after the results obtained in a pivotal study assessing the antifracture efficacy of the drug ... [more ▼]

In the mid-1980s, calcitonin was used as a potential treatment for postmenopausal osteoporosis. However, after the results obtained in a pivotal study assessing the antifracture efficacy of the drug showed an absence of reduction in nonvertebral fractures, calcitonin has almost completely disappeared from the osteoporosis armomentarium. The development of a new ‘high-tech’ oral formulation of salmon calcitonin and the demonstration, in several in vitro and in vivo models of osteoarthritis, that this drug could exert beneficial effects on the chondrocytes and on the development of experimental osteoarthritis has generated some interest in this old molecule. However, at this stage, results from clinical trials remain inconclusive and caution should be exerted before considering oral calcitonin as a breakthrough in the management of osteoarthritis. [less ▲]

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See detailGlucosamine sulphate in the treatment of knee osteoarthritis: cost-effectiveness comparison with paracetamol.
Scholtissen, S.; Bruyère, Olivier ULg; Neuprez, A. et al

in International Journal of Clinical Practice (2010), 64(6), 756-62

INTRODUCTION: The aim of this study was to explore the cost-effectiveness of glucosamine sulphate (GS) compared with paracetamol and placebo (PBO) in the treatment of knee osteoarthritis. For this purpose ... [more ▼]

INTRODUCTION: The aim of this study was to explore the cost-effectiveness of glucosamine sulphate (GS) compared with paracetamol and placebo (PBO) in the treatment of knee osteoarthritis. For this purpose, a 6-month time horizon and a health care perspective was used. MATERIAL AND METHODS: The cost and effectiveness data were derived from Western Ontario and McMaster Universities Osteoarthritis Index data of the Glucosamine Unum In Die (once-a-day) Efficacy trial study by Herrero-Beaumont et al. Clinical effectiveness was converted into utility scores to allow for the computation of cost per quality-adjusted life year (QALY) For the three treatment arms Incremental Cost-Effectiveness Ratio were calculated and statistical uncertainty was explored using a bootstrap simulation. RESULTS: In terms of mean utility score at baseline, 3 and 6 months, no statistically significant difference was observed between the three groups. When considering the mean utility score changes from baseline to 3 and 6 months, no difference was observed in the first case but there was a statistically significant difference from baseline to 6 months with a p-value of 0.047. When comparing GS with paracetamol, the mean baseline incremental cost-effectiveness ratio (ICER) was dominant and the mean ICER after bootstrapping was -1376 euro/QALY indicating dominance (with 79% probability). When comparing GS with PBO, the mean baseline and after bootstrapping ICER were 3617.47 and 4285 euro/QALY, respectively. CONCLUSION: The results of the present cost-effectiveness analysis suggested that GS is a highly cost-effective therapy alternative compared with paracetamol and PBO to treat patients diagnosed with primary knee OA. [less ▲]

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See detailPotential Clinical and Economic Impact of Nonadherence with Osteoporosis Medications.
Hiligsmann, Mickaël ULg; Rabenda, Véronique ULg; Gathon, Henry-Jean ULg et al

in Calcified Tissue International (2010), 86

This study aims to estimate the potential clinical and economic implications of therapeutic adherence to bisphosphonate therapy. A validated Markov microsimulation model was used to estimate the impact of ... [more ▼]

This study aims to estimate the potential clinical and economic implications of therapeutic adherence to bisphosphonate therapy. A validated Markov microsimulation model was used to estimate the impact of varying adherence to bisphosphonate therapy on outcomes (the number of fractures and the quality-adjusted life-years [QALYs]), health-care costs, and the cost-effectiveness of therapy compared with no treatment. Adherence was divided into persistence and compliance, and multiple scenarios were considered for both concepts. Analyses were performed for women aged 65 years with a bone mineral density T-score of -2.5. Health outcomes and the cost-effectiveness of therapy improved significantly with increasing compliance and/or persistence. In the case of real-world persistence and with a medical possession ratio (MPR; i.e., the number of doses taken divided by the number of doses prescribed) of 100%, the QALY gain and the number of fractures prevented represented only 48 and 42% of the values estimated assuming full persistence, respectively. These proportions fell to 27 and 23% with an MPR value of 80%. The costs per QALY gained, for branded bisphosphonates (and generic alendronate), were estimated at <euro>19,069 (<euro>4,871), <euro>32,278 (<euro>11,985), and <euro>64,052 (<euro>30,181) for MPR values of 100, 80, and 60%, respectively, assuming real-world persistence. These values were <euro>16,997 (<euro>2,215), <euro>24,401 (<euro>6,179), and <euro>51,750 (<euro>20,569), respectively, assuming full persistence. In conclusion, poor compliance and failure to persist with osteoporosis medications results not only in deteriorating health outcomes, but also in a decreased cost-effectiveness of drug therapy. Adherence therefore remains an important challenge for health-care professionals treating osteoporosis. [less ▲]

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See detailCost-utility of long-term strontium ranelate treatment for postmenopausal osteoporotic women.
Hiligsmann, Mickaël ULg; Bruyère, Olivier ULg; Reginster, Jean-Yves ULg

in Osteoporosis International (2010), 21

The results of this study suggested that long-term treatment with strontium ranelate over 5 years is cost-effective compared to no treatment for postmenopausal osteoporotic women. INTRODUCTION: This study ... [more ▼]

The results of this study suggested that long-term treatment with strontium ranelate over 5 years is cost-effective compared to no treatment for postmenopausal osteoporotic women. INTRODUCTION: This study aims to estimate the cost-effectiveness of long-term strontium ranelate treatment for postmenopausal osteoporotic women. METHODS: A validated Markov microsimulation model with a Belgian healthcare cost perspective was used to assess the cost per quality-adjusted life-year (QALY) of strontium ranelate compared to no treatment, on a basis of calcium/vit D supplementation if needed. Analyses were performed for women aged 70, 75, and 80 years either with a bone mineral density T-score </= -2.5 SD or with prevalent vertebral fractures. The relative risk of fracture during therapy was derived from the Treatment of Peripheral Osteoporosis Study trial over 5 years of treatment. Parameter uncertainty was evaluated using both univariate and probabilistic sensitivity analyses. RESULTS: Strontium ranelate was cost-saving at the age of 80 years in both populations. For women with a T-score </= -2.5 SD, the costs per QALY gained of strontium ranelate were respectively <euro>15,096 and <euro>6,913 at 70 and 75 years of age while these values were <euro>23,426 and <euro>9,698 for women with prevalent vertebral fractures. Sensitivity analyses showed that the results were robust over a wide range of assumptions. CONCLUSION: This study suggested that, compared to no treatment, long-term strontium ranelate treatment is cost-effective for postmenopausal osteoporotic women. [less ▲]

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See detailCost-effectiveness of strontium ranelate versus risedronate in the treatment of postmenopausal osteoporotic women aged over 75 years.
Hiligsmann, Mickaël ULg; Bruyère, Olivier ULg; Reginster, Jean-Yves ULg

in Bone (2010), 46(2), 440-6

OBJECTIVE: To estimate the cost-effectiveness of strontium ranelate in the treatment of postmenopausal osteoporotic women aged over 75 years. MATERIALS AND METHODS: A validated Markov microsimulation ... [more ▼]

OBJECTIVE: To estimate the cost-effectiveness of strontium ranelate in the treatment of postmenopausal osteoporotic women aged over 75 years. MATERIALS AND METHODS: A validated Markov microsimulation model with a Belgian payer's perspective estimated the cost per quality-adjusted life-year (QALY) of a 3-year strontium ranelate treatment compared with no treatment and with the bisphosphonate risedronate. Data on the effect of both treatments on fracture risk were taken from the Cochrane Database of Systematic Reviews. Analyses were performed for postmenopausal women aged 75 and 80 years, either with a diagnosis of osteoporosis (i.e. bone mineral density T-score </=-2.5 SD) or with prevalent vertebral fractures (PVF). Parameter uncertainty was evaluated using both one-way and probabilistic sensitivity analyses. RESULTS: Strontium ranelate was dominant (i.e. more effective and less costly) versus risedronate for women with osteoporosis aged over 75 years and for women with PVF aged 80 years. The cost per QALY gained of strontium ranelate compared with risedronate at 75 years of age was euro11,435 for women with PVF. When compared with no treatment, the costs per QALY gained of strontium ranelate were euro15,588 and euro7,708 at 75 and 80 years of age for women with osteoporosis; the equivalent values were euro16,518 and euro6,015 for women with PVF. Probabilistic sensitivity analyses showed that strontium ranelate was generally more cost-effective than risedronate, in the range of 60% in all cases. CONCLUSION: The results of this study suggest that strontium ranelate is a cost-effective strategy, in a Belgian setting, for the treatment of postmenopausal osteoporotic women aged over 75 years. [less ▲]

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See detailCost-Effectiveness of Osteoporosis Screening Followed by Treatment: The Impact of Medication Adherence.
Hiligsmann, Mickaël ULg; Gathon, Henry-Jean ULg; Bruyère, Olivier ULg et al

in Value in Health (2010), 13(4), 394-401

ABSTRACT Objective: To estimate the impact of medication adherence on the cost-effectiveness of mass-screening by bone densitometry followed by alendronate therapy for women diagnosed with osteoporosis ... [more ▼]

ABSTRACT Objective: To estimate the impact of medication adherence on the cost-effectiveness of mass-screening by bone densitometry followed by alendronate therapy for women diagnosed with osteoporosis. Methods: A validated Markov microsimulation model with a Belgian health-care payer perspective and a lifetime horizon was used to assess the cost per quality-adjusted life year (QALY) gained of the screening/treatment strategy compared with no intervention. Real-world adherence to alendronate therapy and full adherence over 5 years were both investigated. The real-world adherence scenario employed adherence data from published observational studies, and medication adherence was divided into persistence, compliance, and primary adherence. Uncertainty was investigated using one-way and probabilistic sensitivity analyses. Results: At 65 years of age, the costs per QALY gained because of the screening/treatment strategy versus no intervention are euro32,008 and euro16,918 in the real-world adherence and full adherence scenarios, respectively. The equivalent values are euro80,836 and euro40,462 at the age of 55 years, and they decrease to euro10,600 and euro1229 at the age of 75 years. Sensitivity analyses show that the presence of the upfront cost of case finding has a substantial role in the impact of medication adherence on cost-effectiveness. Conclusion: This study indicates that nonadherence with osteoporosis medications substantially increases the incremental cost-effectiveness ratio of osteoporosis screening strategies. All aspects of medication adherence (i.e., compliance, persistence, and primary adherence) should therefore be reported and included in pharmacoeconomic analyses, and especially in the presence of the upfront cost of case finding (such as screening cost). [less ▲]

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See detailThe clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients.
Hiligsmann, Mickaël ULg; Rabenda, Véronique ULg; Bruyère, Olivier ULg et al

in Health Policy (2010), 96

OBJECTIVES: This study aims to estimate the clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients and the potential cost-effectiveness of adherence-enhancing ... [more ▼]

OBJECTIVES: This study aims to estimate the clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients and the potential cost-effectiveness of adherence-enhancing interventions. METHODS: A validated Markov microsimulation model estimated costs and outcomes (i.e. the number of fractures and the quality-adjusted life-year (QALY)) for three adherence scenarios: no treatment, real-world adherence and full adherence over 3 years. The real-world adherence scenario employed data from a published observational study. The incremental cost per QALY gained was estimated and compared across the three adherence scenarios. RESULTS: The number of fractures prevented and the QALY gain obtained at real-world adherence levels represented only 38.2% and 40.7% of those expected with full adherence, respectively. The cost per QALY gained of real-world adherence compared with no treatment was estimated at euro10279, and full adherence was found to be cost-saving compared with real-world adherence. CONCLUSIONS: This study suggests that more than half of the potential clinical benefits from oral bisphosphonates in patients with osteoporosis are lost due to poor adherence with treatment. Depending on their cost, interventions with improved adherence to therapy have the potential to be an attractive use of resources. [less ▲]

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See detailCost-effectiveness of strontium ranelate for the prevention and treatment of osteoporosis
Hiligsmann, Mickaël ULg; Vanoverberghe, Marie ULg; Neuprez, Audrey ULg et al

in Expert Review of Pharmacoeconomics & Outcomes Research (2010), 10(4), 359-366

Strontium ranelate has recently been introduced for the prevention and treatment of osteoporosis in Europe and in many countries worldwide. This study aims to review the published cost-effectiveness ... [more ▼]

Strontium ranelate has recently been introduced for the prevention and treatment of osteoporosis in Europe and in many countries worldwide. This study aims to review the published cost-effectiveness literature pertaining to strontium ranelate. Six studies were identified: two in United Kingdom, two in Belgium and two in Sweden. The findings were consistent across the literature, suggesting that strontium ranelate is a cost-saving drug for women with osteoporosis aged over 80 years of age, and it is a cost-effective treatment compared with no treatment for osteoporotic women aged over 70 years and for younger women with clinical risk factors for fragility fracture. Strontium ranelate was also shown to be cost-effective compared with branded risedronate in osteoporotic women over 75 years. Further analyses are required to assess effectiveness and adherence to strontium ranelate in real-life settings, as well as to evaluate the cost-effectiveness of strontium ranelate in other countries and in populations of men. [less ▲]

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See detailPotential cost-effectiveness of denosumab for the treatment of postmenopausal osteoporotic women.
Hiligsmann, Mickaël ULg; Reginster, Jean-Yves ULg

in BONE (2010), 47

Denosumab has recently been shown to be safe and to significantly reduce the risk of vertebral, hip and non-vertebral fractures in the "Fracture REduction Evaluation of Denosumab in Osteoporosis every ... [more ▼]

Denosumab has recently been shown to be safe and to significantly reduce the risk of vertebral, hip and non-vertebral fractures in the "Fracture REduction Evaluation of Denosumab in Osteoporosis every 6Months" (FREEDOM) Trial. Besides the clinical profile of a new drug, it becomes increasingly important to assess whether the drug represents good value for money. This study aims to examine the potential cost-effectiveness of denosumab in the treatment of postmenopausal osteoporotic women. An updated version of a validated Markov microsimulation model was used to estimate the cost (euro2009) per quality-adjusted life-year (QALY) gained of a 3-year denosumab treatment compared with no treatment. The model was populated with cost and epidemiological data for Belgium from a health-care perspective and the base-case population was defined from the FREEDOM Trial. The effect of denosumab after treatment cessation was conservatively assumed to decline linearly over 1year. Uncertainty was investigated using one-way and probabilistic sensitivity analyses. In particular, additional analyses were performed in populations (over 60years) where osteoporosis medications are currently reimbursed in many European countries, i.e. with bone mineral density (BMD) T-score</=-2.5 or prevalent vertebral fracture. In the base-case analysis, the cost per QALY gained of denosumab compared with no treatment was estimated at euro28,441. This value decreased to euro15,532 and to euro11,603 for women with a BMD T-score of -2.5 or prevalent vertebral fracture, respectively. Additional analyses showed that the cost-effectiveness of denosumab fall below commonly accepted threshold of euro30,000per QALY gained for women with a BMD T-score </=-2.5 or prevalent vertebral fracture, over the entire age range examined (60-80years). The results were robust under a wide range of plausible assumptions. In conclusion, this study suggests, on the basis of currently available data, that denosumab is cost-effective compared with no treatment for postmenopausal Belgian women with low bone mass and who are similar to patients included in the FREEDOM Trial. In addition, denosumab was found to be cost-effective in population currently reimbursed in Europe with T-score</=-2.5 or prevalent vertebral fracture, aged 60years and above. Additional data are needed on the relative cost-effectiveness compared with other anti-osteoporotic agents and on the long-term safety of denosumab. [less ▲]

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See detailRationalisation du remboursement des médicaments de l'ostéoporose : de la mesure isolée de la densité osseuse à l’intégration des facteurs cliniques de risque fracturaire. Validation de l’algorithme FRAX®
Neuprez, Audrey ULg; Johansson, H.; Kanis, J. et al

in Revue Médicale de Liège (2009), 64(12), 612-619

RESUME : Cette étude a pour but d’adapter à la population belge l’algorithme FRAX® récemment publié par l’Organisation Mondiale de la Santé (OMS) et permettant de calculer, dans les deux sexes, le risque ... [more ▼]

RESUME : Cette étude a pour but d’adapter à la population belge l’algorithme FRAX® récemment publié par l’Organisation Mondiale de la Santé (OMS) et permettant de calculer, dans les deux sexes, le risque absolu de fractures ostéoporotiques, à 10 ans. Nous nous sommes attachés à quantifier le risque fracturaire correspondant aux critères actuellement appliqués, en Belgique, pour le remboursement des médicaments de l’ostéoporose et à identifier les situations cliniques correspondant à une probabilité équivalente de fracture. Les probabilités fracturaires ont été calculées, à partir des incidences de fractures et de décès publiées, pour la population belge. Ces probabilités prennent en considération l’âge, le sexe, l’existence de facteurs cliniques de risque (FCR) et la densité minérale osseuse (DMO), mesurée au niveau de la zone propre du col fémoral. L’algorithme FRAX® permet d’identifier différents scénarios d’intervention, en Belgique, correspondant à un risque fracturaire identique ou supérieur à celui servant de base aux critères actuels de remboursement des médicaments. Il est donc possible de recommander une modification des attitudes actuelles, délaissant une stratégie basée sur une évaluation dichotomique de la DMO, au profit d’une intégration progressive des FCR qui permettra, in fine, une meilleure identification des patients à risque accru de fracture. Cette approche devra être substantiée par des analyses pharmaco-économiques appropriées. [less ▲]

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See detailThe clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients
Hiligsmann, Mickaël ULg; Rabenda, Véronique ULg; Bruyère, Olivier ULg et al

in Arthritis and Rheumatism (2009, October), 60(number 10 (suppl.)), 328

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See detailThe clinical and economic burden of nonadherence with osteoporosis medications
Hiligsmann, Mickaël ULg; Rabenda, Véronique ULg; Bruyère, Olivier ULg et al

in Value in Health (2009, October), 12(7), 444

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See detailThe clinical and economic burden of nonadherence with oral bisphosphonates in osteoporotic patients
Hiligsmann, Mickaël ULg; Rabenda, Véronique ULg; Reginster, Jean-Yves ULg

in Annals of the Rheumatic Diseases (2009, June), 68(S3), 667

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See detailCost-utility of denosumab for the treatment of postmenopausal osteoporotic women
Hiligsmann, Mickaël ULg; Reginster, Jean-Yves ULg

in Osteoporosis International (2009, March), 20(S1), 5

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See detailClinical en economic implications of non-adherence with osteoporosis medications
Hiligsmann, Mickaël ULg; Rabenda, Véronique ULg; Gathon, Henry-Jean ULg et al

in Osteoporosis International (2009, March), 20(S1), 16

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See detailCost-effectiveness of strontium ranelate versus intravenous ibandronate in the treatment of postmenopausal women
Hiligsmann, Mickaël ULg; Neuprez, Audrey ULg; Scholtissen, Sophie et al

in Osteoporosis International (2009, March), 20(S1), 130

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