Cost-Effectiveness of Alendronate in Postmenopausal Women with Low Bone Mass without Osteoporosis or Previous Fracture

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The summary below is from the full report titled "Cost-Effectiveness of Alendronate Therapy for Osteopenic Postmenopausal Women." It is in the 3 May 2005 issue of Annals of Internal Medicine (volume 142, pages 734-741). The authors are J.T. Schousboe, J.A. Nyman, R.L. Kane, and K.E. Ensrud.

What is the problem and what is known about it so far?

Bone loss commonly occurs among women after menopause and can lead to fractures. Alendronate is a medicine that can prevent or slow bone loss. Osteopenia is the medical term for bones that are less dense. Severe loss of bone density is called osteoporosis. The risk for bone fractures is greater with osteoporosis than with osteopenia. Doctors use a special test called dual-energy x-ray absorptiometry (DEXA) to measure bone density. Treatment with alendronate or another medicine in the same class has become standard practice for people with osteoporosis or those who have had a fracture because of osteopenia. However, whether the potential costs and side effects of alendronate are worth the potential benefits for women with osteopenia but without osteoporosis or previous fracture is less clear.

Why did the researchers do this particular study?

To find out whether the potential costs and side effects of alendronate are worth the potential benefits for postmenopausal women with osteopenia but without osteoporosis or previous fracture.

Who was studied?

Rather than studying actual patients, the researchers used a computer model to simulate what would happen to a "virtual" group of postmenopausal women 55 to 75 years of age who had osteopenia but no osteoporosis or previous fracture.

How was the study done?

The researchers used published studies to estimate the costs and outcomes of 2 treatment strategies: 5 years of alendronate therapy or no drug treatment. The costs included the costs of the drug and monitoring patients taking it, and the benefits included prevention of fractures and complications of fractures.

What did the researchers find?

The researchers estimated that 5 years of alendronate treatment for postmenopausal women with osteopenia but without osteoporosis or previous fracture would cost between $70,000 and $332,000 per year of healthy life that it saved. This amount is more than Americans are typically willing to pay for health care interventions. However, if alendronate became less expensive or new studies showed that alendronate reduces fractures in osteopenia more than current studies suggest, then it would become a more attractive treatment option.

What were the limitations of the study?

This study was a computer simulation, so we cannot be sure what the results would be in actual patients. However, studies of this problem using actual patients are unlikely to be done soon (if ever).

What are the implications of the study?

Alendronate does not seem to be an economically attractive option for postmenopausal women with osteopenia but without osteoporosis or previous fracture.