Cost-Effectiveness of Alendronate Therapy for Osteopenic Postmenopausal Women

3 May 2005 | Volume 142 Issue 9 | Pages 734-741

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.

Editors' Notes Context Many postmenopausal women have osteopenia but not osteoporosis or fracture history. Information about the cost-effectiveness of treating such women with alendronate should guide clinical recommendations. Contribution The investigators estimate that the costs of treating postmenopausal women with osteopenia (femoral neck T-scores > –2.5) for 5 years with alendronate range from $70 000 to $332 000 per quality-adjusted life-year. Cautions Unless the cost of alendronate decreases or new data show that alendronate reduces fracture risk more than is currently thought, treatment of osteopenia with alendronate costs more than Americans are typically willing to pay for health care interventions. –The Editors

 

Author and Article Information

From Park Nicollet Health Services, University of Minnesota, and Veterans Administration Medical Center, Minneapolis, Minnesota.

Potential Financial Conflicts of Interest: Grants received: J.T. Schousboe (Hologic, Inc.), K.E. Ensrud (Eli Lilly & Co., Pfizer, NPB Pharmaceuticals).

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.

Current Author Addresses: Dr. Schousboe: Park Nicollet Clinic, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416.

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.

Dr. Ensrud: Department of Medicine, Minneapolis Veterans Administration Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.

Author Contributions: Conception and design: J.T. Schousboe, R.L. Kane.

Analysis and interpretation of the data: J.T. Schousboe, J.A. Nyman, K.E. Ensrud.

Drafting of the article: J.T. Schousboe.

Critical revision of the article for important intellectual content: J.T. Schousboe, R.L. Kane, K.E. Ensrud.

Final approval of the article: J.T. Schousboe, R.L. Kane, K.E. Ensrud.

Administrative, technical, or logistic support: J.T. Schousboe, R.L. Kane.

Collection and assembly of data: J.T. Schousboe.

Read all Rapid Responses

Alendronate therapy and cost

Lonnie B. Hanauer

Annals Online, 6 May 2005 [Full text]