title: Cost-effectiveness of osteoporosis screening and treatment with hormone replacement therapy, raloxifene, or alendronate.
abstract: Recent information about osteoporosis treatments and their nonfracture side effects suggests the need for a new cost-effectiveness analysis. The authors estimate the cost effectiveness of screening women for osteoporosis at age 65 and treating those who screen positive with hormone replacement therapy (HRT), raloxifene, or alendronate. A Markov model of osteoporosis disease progression simulates costs and outcomes of women aged 65 years. Incremental cost effectiveness ratios of screen-and-treat strategies are calculated relative to a no-screen, no-treat (NST) strategy. Disease progression parameters are derived from clinical trials; cost and quality-of-life parameters are based on review of cost databases and cost-effectiveness studies. Women are screened using dual-energy x-ray absorptiometry, and women screening positive are treated with HRT, raloxifene, or alendronate. Screening and treatment with HRT increase costs and lower quality-adjusted life years (QALYs; relative to the NST strategy). The only scenario (of several) in the sensitivity analysis in which HRT increases QALYs is when it is assumed that there are no drug-related (nonfracture) health effects. Raloxifene increases costs and QALYs; its cost-effectiveness ratio is $447,559 per QALY. When prescribed for the shortest duration modeled, raloxifene's cost-effectiveness ratio approached $133,000 per QALY. Alendronate is the most cost-effective strategy; its cost-effectiveness ratio is $72,877 per QALY. Alendronate's cost-effectiveness ratio approaches $55,000 per QALY when treatment effects last for 5 years or the discount rate is set to zero. The authors conclude that screening and treating with alendronate are more cost-effective than screening and treating with raloxifene or HRT. Relative to an NST strategy, alendronate has a fairly good cost-effectiveness ratio.
authors.affiliation: Division for Health Services and Social Policy Research, RTI International (Research Triangle Institute), 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA. lmobley@rti.org
authors.forename: Lee R
authors.initials: LR
authors.lastname: Mobley
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hoerger
authors.forename: John S
authors.initials: JS
authors.lastname: Wittenborn
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Galuska
authors.forename: Jaya K
authors.initials: JK
authors.lastname: Rao
mesh_terms: D000368:Aged; D019386:Alendronate / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D020249:Hormone Replacement Therapy / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D010024:Osteoporosis / Q000188:drug therapy*; D019057:Quality-Adjusted Life Years; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use*; D014481:United States
chemical_list: D020849:Raloxifene Hydrochloride; D019386:Alendronate