choice of treatments of osteoporosis in vietnam le anh thu, md, phd department of rheumatology cho...

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