Cost Effectiveness of the German Screen-and-Treat Strategy for Postmenopausal Osteoporosis
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- Mueller, D., Weyler, E. & Gandjour, A. Pharmacoeconomics (2008) 26: 513. doi:10.2165/00019053-200826060-00005
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The German osteology umbrella organization, Dachverband Osteologie (DVO), has published a new guideline for the secondary prevention of osteoporotic fractures. According to the guideline, women are screened using dual x-ray absorptiometry (DXA). Those with an absolute 10-year fracture risk ≥30% are treated with bisphosphonates such as alendronate or risedronate for 4 years or with teriparatide for 18 months.
To determine the cost effectiveness of the screen-and-treat strategy versus no intervention in women of the general population aged 50–90 years in Germany.
Cost-utility and budget-impact analyses were performed from the perspective of the statutory health insurance (SHI). A Markov model with a 1-year cycle length simulated costs and benefits (QALYs), discounted at 3%, over a lifetime horizon. The number of women correctly diagnosed by pre-tests and DXA as having a 10-year fracture risk of ≥30% was estimated for different age groups (50–60, 60–70, 70–80 and 80–90 years). Incremental cost-effectiveness ratios (ICERs) were calculated; all costs are presented in €, year 2006 values. Robustness of the results was tested by a probabilistic Monte Carlo simulation.
Alendronate was the most cost-effective drug in all age groups; the ICERs were €3849, €16 589, €6600 and €2337 per QALY for 50-, 60-, 70- and 80-year-old women, respectively, followed by risedronate. Teriparatide was dominated in every age group. Implementing the screen-and-treat strategy would result in annual costs of €175 million for alendronate (€181 million for risedronate) or 0.14% of the SHI annual budget. Results were robust in the sensitivity analysis.
While the screen-and-treat strategy would result in a substantial cost increase for the SHI, the use of alendronate within such a strategy appears cost effective when compared with many generally accepted medical interventions.