The reporting of this current research followed the recommendations for the conduct of economic evaluations in osteoporosis (Hiligsmann et al., 2019 (link)). A Markov microsimulation model was previously built and validated to evaluate the cost-effectiveness of osteoporosis management in Japan and in the USA by one of our authors (Mori et al., 2017a (link); Mori et al., 2017b (link); Mori et al., 2019 (link)). The model was recently updated to compare the cost-effectiveness of zoledronic acid with alendronate in Chinese postmenopausal osteoporotic women with no fracture history at different ages of group initiation. The primary end point of this study was the incremental cost-effectiveness ratios (ICERs) expressed as cost per quality-adjusted life-years (QALYs) for one strategy compared with the other. The model aimed to simulate the entire lifetime of participants (up to 105 years old or until death) to capture relevant costs and consequences of fractures experienced during the treatment period. We estimated the cost-effectiveness from health care payer (only including direct medical costs) perspective. Costs and QALYs were discounted at an annual rate of 3% according to China Guidelines for Pharmacoeconomic Evaluations (Liu, 2011 ). Three times the per capita gross domestic product (GDP) value of China in 2018 ($29,340) was used as the willingness-to-pay (WTP) threshold. The economic modeling was developed in TreeAge Pro 2018 Software.
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