title: Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women.
abstract: 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.
authors.affiliation: Park Nicollet Health Services, University of Minnesota, and Veterans Administration Medical Center, Minneapolis, Minnesota 55416, USA. schouj@parknicollet.com
authors.forename: John T
authors.initials: JT
authors.lastname: Schousboe
authors.forename: John A
authors.initials: JA
authors.lastname: Nyman
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
mesh_terms: 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
chemical_list: D019386:Alendronate