title: Cost-effectiveness of a fixed dose combination of alendronate and cholecalciferol in the treatment and prevention of osteoporosis in the United Kingdom and The Netherlands.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of a fixed dose combination of alendronate 70 mg and cholecalciferol 2800 IU (alendronate/vitamin D3; Fosavance) versus no treatment, alendronate with dietary vitamin D supplements and ibandronate in the treatment of osteoporosis in the UK and Netherlands.
  
  
  METHODS
  A patient simulation model was developed. One-year cycles included health states related to hip, vertebral, wrist and proximal humerus fractures, as well as death due to hip fractures and other causes. Effect of treatment was extracted from alendronate and ibandronate clinical trials. Direct costs and utilities were derived from other literature. Analyses were performed for women with a history of vertebral fractures and osteoporosis aged 50, 60, 70 and 80 years. Probabilistic sensitivity analyses were undertaken to estimate the uncertainty of outcomes.
  
  
  RESULTS
  In the UK, alendronate/vitamin D3 was cost-effective compared to no treatment in women 70 years and older with osteoporosis ( pound17 439 per quality-adjusted life year [QALY] gained) and women 60 years and older with a history of vertebral fractures ( pound29 283 per QALY gained). For women 80 years of age alendronate/vitamin D3 was cost-saving combined with QALY gains. Alendronate/vitamin D3 was cost-saving relative to alendronate with dietary supplements. Relative to ibandronate, alendronate/vitamin D3 was cost-effective in women 50 years ( pound19 095 per QALY gained) and economically dominant in women 60 years or older. Comparable results were observed for the Netherlands.
  
  
  CONCLUSIONS
  Given the underlying assumptions and data used, this economic modelling study showed that alendronate/vitamin D3 is cost-effective in women 70 years or older with osteoporosis and in women 60 years or older with a history of vertebral fractures in the UK and Netherlands. Alendronate/vitamin D3 is economically dominant over ibandronate in women with a history of vertebral fractures aged 60 and over and cost-saving relative to alendronate with dietary supplements.
authors.affiliation: Mapi Values, Houten, The Netherlands. jeroen.jansen@mapivalues.com
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Jansen
authors.forename: Sabine
authors.initials: S
authors.lastname: Gaugris
authors.forename: Gert
authors.initials: G
authors.lastname: Bergman
authors.forename: Shuvayu S
authors.initials: SS
authors.lastname: Sen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000008:administration & dosage* / Q000191:economics*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000191:economics*; D002762:Cholecalciferol / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D004164:Diphosphonates / Q000008:administration & dosage / Q000191:economics; D004338:Drug Combinations; D016527:Drug Costs; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D000077557:Ibandronic Acid; D008875:Middle Aged; D018803:Models, Economic; D009426:Netherlands / Q000453:epidemiology; D010024:Osteoporosis / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D010349:Patient Compliance; D016544:Patient Simulation; D019057:Quality-Adjusted Life Years; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D004338:Drug Combinations; D002762:Cholecalciferol; D000077557:Ibandronic Acid; D019386:Alendronate