Cost Effectiveness of Alendronate (Fosamax®) for the Treatment of Osteoporosis and Prevention of Fractures
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Background: The Fracture Intervention Trial (FIT) demonstrated that the bisphosphonate alendronate reduces the risk of hip, spine and wrist fracture in osteoporotic women by approximately one half.
Objective: To use data from FIT to conduct a cost-effectiveness analysis of alendronate.
Design: A Markov model was developed for a cohort of Swedish women, comparable in relative fracture risk to the women enrolled in the FIT vertebral fracture arm (i.e. age 71 years with low bone mass plus at least one prior spine fracture). The women in the model (with low bone mass and a previous spine fracture) were exposed to alendronate therapy and transitioned over time from a ‘well’ health state to health states of ‘hip fracture’, ‘spine fracture’, ‘wrist fracture’ or ‘death’. All costs were calculated in 2000 Swedish kronors (SEK).
Time horizon: In the Markov model our base-case treatment duration was 5 years followed by a 5-year period where the benefit declined linearly to 0.
Results: We found that treating 71-year-old osteoporotic women with a prior spine fracture with alendronate resulted in a cost per quality-adjusted life-year (QALY) gained of SEK76 000, which is well below the threshold for cost effectiveness of SEK300 000. For women aged 65 years, the cost-effectiveness ratio increased to SEK173 000 and for women aged 77 years, the cost-effectiveness ratio decreased to SEK52 000.
Conclusions: Treating older osteoporotic women with alendronate was more cost effective than treating younger women with osteoporosis, and treating osteoporotic women with prior spine fracture was more cost effective than treating osteoporotic women without prior spine fracture. However, the costs per QALY gained for all populations studied were below generally accepted thresholds for cost effectiveness.
- Kanis, JA, Melton, LJ, Christiansen, C (1994) The diagnosis of osteoporosis. J Bone Miner Res 9: pp. 1137-41 CrossRef
- Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical report series. World Health Organization, Geneva
- Ray, NF, Chan, JK, Thamer, M (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12: pp. 24-35 CrossRef
- Black, DM, Cummings, SR, Karpf, DB (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures: Fracture Intervention Trial Research Group. Lancet 348: pp. 1535-41 CrossRef
- Cummings, SR, Black, DM, Thompson, DE (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280: pp. 2077-82 CrossRef
- Goldman, L, Garber, AM, Grover, SA (1996) Task force 6: cost effectiveness of assessment and management of risk factors. J Am Coll Cardiol 27: pp. 1020-30 CrossRef
- Jönsson, B, Christiansen, C, Johnell, O (1996) Cost-effectiveness of fracture prevention in established osteoporosis. Scand J Rheumatol Suppl 103: pp. 30-8 CrossRef
- Zethraeus, N, Johannesson, M, Jönsson, B (1999) A computer model to analyse the cost-effectiveness of hormone replacement therapy. Int J Technol Assess Health Care 15: pp. 352-65
- Kanis, JA, Johnell, O, Odén, A (2000) Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 11: pp. 669-74 CrossRef
- National Center for Health Statistics. Third National Health and Nutrition Examination Survey, 1988–1994. Centers for Disease Control and Prevention, Hyattsville (MD)
- Jönsson, B (1998) Targeting high-risk populations. Osteoporos Int 8: pp. S13-6
- Tonino, RP, Meunier, PJ, Emkey, R (2000) Skeletal benefits of alendronate: 7-year treatment of postmenopausal osteoporotic women. Phase III Osteoporosis Treatment Study Group. J Clin Endocrinol Metab 85: pp. 3109-15 CrossRef
- Ravn, P, Bidstrup, M, Wasnich, RD (1999) Alendronate and estrogen-progestin in the long-term prevention of bone loss: 4-year results from the early postmenopausal intervention cohort study. A randomized, controlled trial. Ann Intern Med 131: pp. 935-42
- Stock, JL, Bell, NH, Chesnut, CH (1997) Increments in bone mineral density of the lumbar spine and hip and suppression of bone turnover are maintained after discontinuation of alendronate in postmenopausal women. Am J Med 103: pp. 291-7 CrossRef
- McClung, M, Clemmesen, B, Daifotis, A (1998) Alendronate prevents postmenopausal bone loss in women without osteoporosis: a double-blind, randomized, controlled trial. Alendronate Osteoporosis Prevention Study Group. Ann Intern Med 128: pp. 253-61
- Zethraeus, N, Strömberg, L, Jönsson, B (1997) The cost of a hip fracture. Acta Orthop Scand 68: pp. 13-7 CrossRef
- The Swedish drug compendium. Stockholm: Linfo Läkemedelsinformation AB, 2000
- Statistical Year Book Sweden. Stockholm: Statistiska Centralbyrån, 2000: 86
- Weinstein, MC (1980) Estrogen use in postmenopausal women: costs, risks, and benefits. N Engl J Med 303: pp. 308-16 CrossRef
- Hillner, BE, Hollenberg, JP, Pauker, SG (1986) Postmenopausal estrogens in prevention of osteoporosis: benefit virtually without risk if cardiovascular effects are considered. Am J Med 80: pp. 1115-27 CrossRef
- Zethraeus N, Borgström F, Johnell O, et al. Costs and quality of life associated with osteoporosis related fractures — results from a Swedish survey. Working paper 512, Stockholm School of Economics. Available from URL: http://swopec.hhs.se/hastef/abs/hastef0512.htm [Accessed 2003 Feb 20]
- Osteoporosis: cost-effectiveness analysis and review of the evidence for prevention, diagnosis and treatment. Osteoporosis Int 8: pp. S1-88 CrossRef
- Dolan, P, Torgerson, D, Kakarlapudi, TK (1999) Health-related quality of life of Colles’ fracture patients. Osteoporos Int 9: pp. 196-9 CrossRef
- Torgerson, DJ, Reid, DM (1997) The economics of osteoporosis and its prevention: a review. Pharmacoeconomics 11: pp. 126-38 CrossRef
- Meunier, PJ (1999) Evidence-based medicine and osteoporosis: a comparison of fracture risk reduction data from osteoporosis randomised clinical trials. Int J Clin Pract 53: pp. 122-9
- Cost Effectiveness of Alendronate (Fosamax®) for the Treatment of Osteoporosis and Prevention of Fractures
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- 1. Department of Orthopaedics, Malmö University Hospital, SE-205 02, Malmö, Sweden
- 2. Center for Health Economics, Stockholm School of Economics, Stockholm, Sweden
- 3. Department of Neuroscience, Occupational Therapy and Elderly Care Research (NEUROTEC), Karolinska Institutet, Stockholm, Sweden
- 4. Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA