Cost-effectiveness strategies to treat osteoporosis in elderly women.
BACKGROUND
Comparing the cost-effectiveness of various antiosteoporotic drugs has not been defined.


METHODS
We determined the cost-effectiveness of calcitonin, raloxifene, bisphosphates and PTH in a base-case cohort of women aged 65 or older with osteoporosis. After bone densitometry, women were stratified into groups of treatment or no treatment. Our outcome goal was a value of dollars 100,000 or less per quality-adjusted life years (QALY). A sensitivity analysis varied nonvertebral fracture reduction and compliance between the two most effective strategies to test various cost per QALY thresholds.


RESULTS
Bisphosphonates displayed the most favorable incremental cost saving and prevented more fractures in our base-case analysis. In a sensitivity analysis, virtually all values of bisphosphonates were under dollars 100,000 per QALY and parathyroid hormone (PTH) was between dollars 100,000 and dollars 200,000 per QALY.


CONCLUSIONS
Only bisphosphonates are cost-effective for fracture prevention in osteoporotic women aged 65 or older and this economic advantage is also maintained in subsets who have a lower relative risk of future fracture.
Pfister
Alfred K
AK
Department of Medicine, West Virginia University School of Medicine, Charleston 25304, USA. apfister@hcs.wvu.edu
Welch
Christine A
CA
Lester
Melissa D
MD
Emmett
Mary K
MK
Saville
Paul D
PD
Duerring
Shea A
SA
D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000191:economics* / Q000627:therapeutic use; D002116:Calcitonin / Q000191:economics / Q000627:therapeutic use; D017046:Cost Savings / Q000191:economics; D003362:Cost-Benefit Analysis; D004164:Diphosphonates / Q000191:economics / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D010281:Parathyroid Hormone / Q000191:economics / Q000627:therapeutic use; D011788:Quality of Life; D020849:Raloxifene Hydrochloride / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D010281:Parathyroid Hormone; D020849:Raloxifene Hydrochloride; D002116:Calcitonin