Potential for bone turnover markers to cost-effectively identify and select post-menopausal osteopenic women at high risk of fracture for bisphosphonate therapy
- First Online:
Introduction and hypothesis
Over half of all fractures among post-menopausal women occur in those who do not have osteoporosis by bone density criteria. Measurement of bone turnover may cost-effectively identify a subset of women with T-score >−2.5 for whom anti-resorptive drug therapy is cost-effective.
Using a Markov model, we estimated the cost per quality adjusted life year (QALY) for five years of oral bisphosphonate compared to no drug therapy for osteopenic post-menopausal women aged 60 to 80 years with a high (top quartile) or low (bottom 3 quartiles) level of a bone turnover marker.
For women with high bone turnover, the cost per QALY gained with alendronate compared to no drug therapy among women aged 70 years with T-scores of −2.0 or −1.5 were $58,000 and $80,000 (U.S. 2004 dollars), respectively. If bisphosphonates therapy also reduced the risk of non-vertebral fractures by 20% among osteopenic women with high bone turnover, then the costs per QALY gained were $34,000 and $50,000 for women age 70 with high bone turnover and T-scores of −2.0 and −1.5, respectively.
Measurement of bone turnover markers has the potential to identify a subset of post-menopausal women without osteoporosis by bone density criteria for whom bisphosphonate therapy to prevent fracture is cost-effective. The size of that subset highly depends on the assumed efficacy of bisphosphonates for fracture risk reduction among women with both a T-score >−2.5 and high bone turnover and the cost of bisphosphonate treatment.
KeywordsBisphosphonates Bone turnover Cost-effectiveness Non-vertebral fracture Vertebral fracture
- 20.Cuddihy MT, Gabriel SE, Crowson CS et al Forearm fractures as predictors of subsequent osteoporotic fractures. Osteoporos Int 9(6):469–475Google Scholar
- 25.United States Life Tables for 1999 (2002) National Vital Statistics Report 50(6):17–18Google Scholar
- 26.Kanis JA, Oden A, Johnell O et al (2003) The components of excess mortality after hip fracture 32(5):468–473Google Scholar
- 29.Drug Topics 2001 Red Book (2001) Montvale, Medical Economics Co, New JerseyGoogle Scholar
- 31.Centers for Medicare and Medicaid Services. Available at: http://cms.hhs.gov/providers/pufdownload/rvudown.asp. Accessed August 12, 2003
- 33.Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey. Available at: http://www.meps.ahrq.gov/. Accessed August 12, 2003
- 35.U.S. Census Bureau, Bureau of Labor Statistics. CPS Annual Demographic Survey. Available at: http://ferret.bls.census.gov/macro/032002/perinc/new05_000.htm. Accessed May 28, 2004
- 36.U.S. Census Bureau. Workforce Participation Rates. Available at: http://factfinder.census.gov/home/saff/main.html?_lang=en. Accessed May 28, 2004