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Cost-Effectiveness of Alendronate Therapy for Osteopenic Postmenopausal Women
- John T. Schousboe, MD, MS;
- John A. Nyman, PhD;
- Robert L. Kane, MD; and
- Kristine E. Ensrud, MD, MPH
- From Park Nicollet Health Services, University of Minnesota, and Veterans Administration Medical Center, Minneapolis, Minnesota.
Abstract
Background: Treatment guidelines recommend drug treatment to prevent fractures for some postmenopausal women who have low bone mass (osteopenia) but do not have osteoporosis or a history of clinical fractures.
Objective: To estimate the societal costs and health benefits of alendronate drug treatment to prevent fractures in postmenopausal women with osteopenia.
Design: Markov model with 8 health states: no fracture, post-distal forearm fracture, post-clinical vertebral fracture, post-radiographic (but clinically inapparent) vertebral fracture, post-hip fracture, post-hip and vertebral fractures, post-other fracture, and death.
Data Sources: Population-based studies of age-specific fracture rates and costs, prospectively measured estimates of disutility after fractures, and the Fracture Intervention Trial of alendronate versus placebo to prevent fracture.
Target Population: Postmenopausal women 55 to 75 years of age with femoral neck T-scores between −1.5 and −2.4.
Time Horizon: Lifetime.
Perspective: Societal.
Interventions: Five years of alendronate therapy or no drug treatment.
Outcome Measures: Costs, quality-adjusted life-years, and incremental cost-effectiveness ratios.
Results of Base-Case Analysis: For women with no additional fracture risk factors, the cost per quality-adjusted life-year gained ranged from $70 000 to $332 000, depending on age and femoral neck bone density.
Results of Sensitivity Analyses: Results were sensitive to changes in fracture risk reduction attributable to alendronate and alendronate cost.
Limitations: Results apply only to postmenopausal white women residing in the United States.
Conclusion: Alendronate therapy for postmenopausal women with femoral neck T-scores better than −2.5 and no history of clinical fractures or other bone mineral density-independent risk factors for fracture is not cost-effective, assuming U.S. costs of alendronate and currently available estimates of alendronate efficacy in osteopenic women.
Article and Author Information
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Potential Financial Conflicts of Interest: Grants received: J.T. Schousboe (Hologic, Inc.), K.E. Ensrud (Eli Lilly & Co., Pfizer, NPB Pharmaceuticals).
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Requests for Single Reprints: John T. Schousboe, MD, MS, Park Nicollet Clinic, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416; e-mail, schouj{at}parknicollet.com.
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Current Author Addresses: Dr. Schousboe: Park Nicollet Clinic, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416.
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Drs. Nyman and Kane: Division of Health Services Research and Policy, School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455.
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Dr. Ensrud: Department of Medicine, Minneapolis Veterans Administration Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.
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Author Contributions: Conception and design: J.T. Schousboe, R.L. Kane.
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Analysis and interpretation of the data: J.T. Schousboe, J.A. Nyman, K.E. Ensrud.
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Drafting of the article: J.T. Schousboe.
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Critical revision of the article for important intellectual content: J.T. Schousboe, R.L. Kane, K.E. Ensrud.
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Final approval of the article: J.T. Schousboe, R.L. Kane, K.E. Ensrud.
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Administrative, technical, or logistic support: J.T. Schousboe, R.L. Kane.
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Collection and assembly of data: J.T. Schousboe.
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