EP22 Teriparatide use in the real world: can we expect cost savings with a switch to generic version?
Authors: Akram Tahreem , Siddique Maham , Javed Hafiz A , Fourmy Joanne , Nisar Muhammad K 
Published: April 2020

Abstract

Background
Teriparatide is an effective treatment option for osteoporosis, however NICE restricts its use to patients with a high disease burden. This was based on a cost effectiveness evaluation of the originator (Forsteo®) and would be different for recently introduced generic preparation. We wished to evaluate the current prescribing behaviour prior to a potential switch to the generic version and associated cost savings.

Methods
All patients prescribed teriparatide since the commencement of specialist osteoporosis service in Aug 2014 at our University teaching hospital covering a population of 350,000 were included. Data were extracted from an electronic database with full access to demographics, population characteristics, disease parameters and medication history.

Results
113 patients were prescribed teriparatide over five years. Mean age of participants was 76 yrs (53-96). They had on average three comorbidities (0-8) with most common being hypertension (n = 44, 38.9%) and inflammatory arthritis (n = 21, 18.5%). Sixteen (14.1%) individuals had concurrent corticosteroids. Median number of fractures prior to therapy were four (0-12). Prior treatments included oral therapy (n = 90,79.6%), IV zoledronate (n = 22, 19.4%) and denosumab (n = 19, 16.8%). 66 (58.4%) of patients only had one prior bone active medication. Mean duration of prior therapy was 62.4 months (9-192 months). 17 (15.0%) patients had chronic kidney disease with lowest eGFR of 38. 41 (36.2%) had Vit D level between 40-75 nmol/L. Median T score was -3.8 (-2.1 - -6.0) which improved to -3.4 (-2.9 - -3.9) after two years.

Conclusion
Our real-world study shows that teriparatide is used predominantly in complex, multi-morbid older individuals with several prior fractures. Despite that teriparatide remains effective for a wide range of individuals including those with inflammatory arthritis and/or concurrent steroid use. Neither moderate CKD nor mild vitamin D insufficiency seems to impact its efficacy. This is in line with recent meta-analysis of real life teriparatide use in complex osteoporosis with multimorbidity. Though NICE stipulates minimum two fractures requirement (unless T score &lt;-4.0), in practice most patients have had more than two fractures perhaps suggesting that clinicians are reserving it for high disease burden or there is a delay in referral and diagnosis. Our study should enhance clinicians’ confidence in its prescribing. It’s notable that the use is higher than current estimates based on NICE cost effectiveness analysis for eligibility of teriparatide. Instead of annual predicted use of 4.8/100,000 population, it was prescribed to 6.4/100,000. This could potentially have a cost impact however the introduction of a generic version would mitigate against it. We calculated our savings to be over £125,000 if all patients were switched. These savings at national level would hopefully improve access to a wider patient cohort and perhaps allow earlier use in the treatment paradigm.

Disclosures
T. Akram None. M. Siddique None. H.A. Javed None. J. Fourmy None. M.K. Nisar None.