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Cost-effectiveness of five versus ten years of alendronate treatment prior to drug holiday for women with osteoporosis

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Abstract

Summary

We performed a cost-effectiveness analysis comparing 5 versus 10 years of alendronate treatment prior to 5-year drug holiday for US postmenopausal women with hip BMD T-scores between − 2.5 and − 3.5. We found that for most postmenopausal women 5 years of treatment prior to drug holiday is the more effective and cost-effective option.

Introduction

We performed a cost-effectiveness analysis to compare 5 versus 10 years of alendronate treatment prior to 5-year drug holiday for postmenopausal osteoporotic women.

Methods

We created an individual-level state-transition microsimulation model to compare 3 treatment strategies for US postmenopausal women with osteoporosis and femoral neck BMD T-scores between − 2.5 and − 3.5 at baseline: recurrent periods of 5 years of alendronate followed by 5 years of drug holiday (alendronate 5/5), recurrent periods of 10 years of alendronate followed by 5 years of drug holiday (alendronate 10/5), and no alendronate treatment.

Results

Base-case analysis revealed for women initiating treatment at ages 50, 60, and 70, the alendronate 5/5 strategy dominated (was more effective and less costly than) the alendronate 10/5 strategy and no treatment. For women age 80, the alendronate 10/5 strategy dominated. When assuming a lower relative risk of nonvertebral fracture during years 6–10 of alendronate treatment than the base-case assumption, the alendronate 10/5 strategy became the most cost-effective strategy even at younger treatment initiation ages. Probabilistic sensitivity analysis results supported the base-case findings; for treatment initiation ages of 50, 60, and 70, the alendronate 5/5 strategy was favored, whereas for treatment initiation age of 80, the alendronate 10/5 strategy was favored; however, there was uncertainty in these findings.

Conclusions

After 5 years of alendronate treatment, younger postmenopausal women (ages 50–70) with osteoporosis would likely benefit from a drug holiday, whereas older women (age 80) are likely to benefit from treatment for 10 years before a drug holiday.

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Funding

Drs. Nayak and Greenspan were supported by grant no. R21AR072930 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Greenspan was also supported by NIH grants P30AG024827, K07AG052668, and R01AG050302 from the National Institute on Aging.

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Authors and Affiliations

  1. Berkeley Madonna, Inc., Berkeley, CA, USA

    S. Nayak

  2. School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    S. L. Greenspan

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  1. S. Nayak
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Correspondence to S. Nayak.

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Conflicts of Interest

Smita Nayak declares no conflict of interest. Susan L. Greenspan receives research funding from Amgen and Radius.

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Nayak, S., Greenspan, S.L. Cost-effectiveness of five versus ten years of alendronate treatment prior to drug holiday for women with osteoporosis. Osteoporos Int 31, 1273–1282 (2020). https://doi.org/10.1007/s00198-019-05258-2

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