Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden: an economic evaluation based on the MORE study.
BACKGROUND
The Multiple Outcomes of Raloxifene Evaluation (MORE) study showed that treatment with raloxifene reduces the risk of vertebral fracture and breast cancer in postmenopausal women with osteoporosis.


OBJECTIVE
Based on the MORE study the aim of the present study was to assess the cost effectiveness of raloxifene (compared with no treatment) for the treatment of osteoporosis in postmenopausal women in Sweden.


METHODS
A revised version of a previously developed computer simulation model was used. The impact of the risk-reducing effect of raloxifene on vertebral fractures and breast cancer on cost effectiveness was analysed using a clinical and a morphometric definition of vertebral fracture. Benefits of raloxifene treatment were measured in quality-adjusted life-years (QALYs) and life-years gained. The study estimated the cost effectiveness mainly from a healthcare perspective but the cost effectiveness taking a societal perspective was also analysed.


RESULTS
Intervention costs (in Swedish kronor [SEK] and euros [euro], year 2001 values) in postmenopausal women with a relative risk of vertebral fracture of 2 were SEK372000 (euro40000), SEK303000 (euro33000) and SEK263000 (euro28000) per QALY for women aged 60, 70 and 80 years, at start of treatment, respectively, when the clinical vertebral definition was used. The cost effectiveness using a clinical morphometric vertebral fracture definition was similar to the cost effectiveness using a clinical vertebral fracture definition.


CONCLUSIONS
In relation to accepted threshold values for cost per QALY in Sweden, this model indicates, with its underlying assumptions and data, that raloxifene (compared with no treatment) is cost effective for the treatment of postmenopausal women at an increased risk of vertebral fracture, from the Swedish healthcare and societal perspectives.
Borgström
Fredrik
F
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden. fredrik.b@healtheconomics.se
Johnell
Olof
O
Kanis
John A
JA
Oden
Anders
A
Sykes
David
D
Jönsson
Bengt
B
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000209:etiology / Q000517:prevention & control; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D018803:Models, Economic; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D019057:Quality-Adjusted Life Years; D020849:Raloxifene Hydrochloride / Q000191:economics* / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D020845:Selective Estrogen Receptor Modulators / Q000191:economics* / Q000627:therapeutic use*; D016103:Spinal Fractures / Q000209:etiology / Q000517:prevention & control; D013548:Sweden; D016896:Treatment Outcome
D020845:Selective Estrogen Receptor Modulators; D020849:Raloxifene Hydrochloride