Cost effectiveness of the German screen-and-treat strategy for postmenopausal osteoporosis.
BACKGROUND
The German osteology umbrella organization, Dachverband Osteologie (DVO), has published a new guideline for the secondary prevention of osteoporotic fractures. According to the guideline, women are screened using dual x-ray absorptiometry (DXA). Those with an absolute 10-year fracture risk > or =30% are treated with bisphosphonates such as alendronate or risedronate for 4 years or with teriparatide for 18 months.


OBJECTIVE
To determine the cost effectiveness of the screen-and-treat strategy versus no intervention in women of the general population aged 50-90 years in Germany.


METHODS
Cost-utility and budget-impact analyses were performed from the perspective of the statutory health insurance (SHI). A Markov model with a 1-year cycle length simulated costs and benefits (QALYs), discounted at 3%, over a lifetime horizon. The number of women correctly diagnosed by pre-tests and DXA as having a 10-year fracture risk of > or =30% was estimated for different age groups (50-60, 60-70, 70-80 and 80-90 years). Incremental cost-effectiveness ratios (ICERs) were calculated; all costs are presented in euro, year 2006 values. Robustness of the results was tested by a probabilistic Monte Carlo simulation.


RESULTS
Alendronate was the most cost-effective drug in all age groups; the ICERs were euro 3849, euro 16 589, euro 6600 and euro 2337 per QALY for 50-, 60-, 70- and 80-year-old women, respectively, followed by risedronate. Teriparatide was dominated in every age group. Implementing the screen-and-treat strategy would result in annual costs of euro 175 million for alendronate (euro 181 million for risedronate) or 0.14% of the SHI annual budget. Results were robust in the sensitivity analysis.


CONCLUSIONS
While the screen-and-treat strategy would result in a substantial cost increase for the SHI, the use of alendronate within such a strategy appears cost effective when compared with many generally accepted medical interventions.
Mueller
Dirk
D
Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany.
Weyler
Eva
E
Gandjour
Afschin
A
D015502:Absorptiometry, Photon / Q000191:economics; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D017410:Practice Guidelines as Topic
D050071:Bone Density Conservation Agents