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Original Article

Cost-effectiveness Strategies to Treat Osteoporosis in Elderly Women

Alfred K. Pfister, MD, Christine A. Welch, MS, Melissa D. Lester, DO, Mary K. Emmett, PHD, Paul D. Saville, MD, Shea A. Duerring
Volume: 99 Issue: 2 February, 2006

Abstract:

Background: Comparing the cost-effectiveness of various antiosteoporotic drugs has not been defined.


Methods: We determined the cost-effectiveness of calcitonin, raloxifene, bisphosphates and PTH in a base-case cohort of women aged 65 or older with osteoporosis.


After bone densitometry, women were stratified into groups of treatment or no treatment. Our outcome goal was a value of $100,000 or less per quality-adjusted life years (QALY). A sensitivity analysis varied nonvertebral fracture reduction and compliance between the two most effective strategies to test various cost per QALY thresholds.


Results: Bisphosphonates displayed the most favorable incremental cost saving and prevented more fractures in our base-case analysis. In a sensitivity analysis, virtually all values of bisphosphonates were under $100,000 per QALY and parathyroid hormone (PTH) was between $100,000 and $200,000 per QALY.


Conclusions: Only bisphosphonates are cost-effective for fracture prevention in osteoporotic women aged 65 or older and this economic advantage is also maintained in subsets who have a lower relative risk of future fracture.


Key Points


* The best incremental cost per QALY and fracture reduction occurred with the bisphosphonate strategy in our base-case analysis.


* At comparable levels of compliance and efficacy of nonvertebral fracture reduction, PTH prevented more fractures but was not cost-effective.


* In a sensitivity analysis, more cost saving occurred by improved effectiveness of nonvertebral fracture prevention than improved compliance.


* Cost analysis studies of osteoporosis should be structured on fracture reduction not only at the vertebral spine, but also at nonvertebral sites. Also, FDA-approved drug doses and reasonable compliance rates should be factored into these evaluations.

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