Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women.
BACKGROUND
Treatment guidelines recommend drug treatment to prevent fractures for some postmenopausal women who have low bone mass (osteopenia) but do not have osteoporosis or a history of clinical fractures.


OBJECTIVE
To estimate the societal costs and health benefits of alendronate drug treatment to prevent fractures in postmenopausal women with osteopenia.


METHODS
Markov model with 8 health states: no fracture, post-distal forearm fracture, post-clinical vertebral fracture, post-radiographic (but clinically inapparent) vertebral fracture, post-hip fracture, post-hip and vertebral fractures, post-other fracture, and death.


METHODS
Population-based studies of age-specific fracture rates and costs, prospectively measured estimates of disutility after fractures, and the Fracture Intervention Trial of alendronate versus placebo to prevent fracture.


METHODS
Postmenopausal women 55 to 75 years of age with femoral neck T-scores between -1.5 and -2.4.


METHODS
Lifetime.


CONCLUSIONS
Societal.


METHODS
Five years of alendronate therapy or no drug treatment.


METHODS
Costs, quality-adjusted life-years, and incremental cost-effectiveness ratios.


RESULTS
For women with no additional fracture risk factors, the cost per quality-adjusted life-year gained ranged from 70,000 dollars to 332,000 dollars, depending on age and femoral neck bone density.


RESULTS
Results were sensitive to changes in fracture risk reduction attributable to alendronate and alendronate cost.


CONCLUSIONS
Results apply only to postmenopausal white women residing in the United States.


CONCLUSIONS
Alendronate therapy for postmenopausal women with femoral neck T-scores better than -2.5 and no history of clinical fractures or other bone mineral density-independent risk factors for fracture is not cost-effective, assuming U.S. costs of alendronate and currently available estimates of alendronate efficacy in osteopenic women.
Schousboe
John T
JT
Park Nicollet Health Services, University of Minnesota, and Veterans Administration Medical Center, Minneapolis, Minnesota 55416, USA. schouj@parknicollet.com
Nyman
John A
JA
Kane
Robert L
RL
Ensrud
Kristine E
KE
D000368:Aged; D019386:Alendronate / Q000191:economics* / Q000627:therapeutic use*; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006801:Humans; D008137:Longitudinal Studies; D008390:Markov Chains; D008875:Middle Aged; D017698:Postmenopause; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity
D019386:Alendronate