title: Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of osteoporosis treatments for women at high fracture risk and estimate the population-level impact of providing bisphosphonate therapy to all eligible high-risk US women.
  
  
  METHODS
  Fractures, healthcare costs, and quality-adjusted life-years (QALYs) were estimated over 10 years using a Markov model.
  
  
  METHODS
  No therapy, risedronate, alendronate, ibandronate, and teriperatide (PTH) were compared among 4 risk groups. Sensitivity analyses examined the robustness of model results for 65-year-old women with low bone density and previous vertebral fracture.
  
  
  RESULTS
  Women treated with a bisphosphonate experienced fewer fractures and more QALYs compared with no therapy or PTH. Total costs were lowest for the untreated cohort, followed by risedronate, alendronate, ibandronate, and PTH in all risk groups except women aged 75 years with previous fracture. The incremental cost-effectiveness of risedronate compared with no therapy ranged from cost saving for the base case to $66,722 per QALY for women aged 65 years with no previous fracture. Ibandronate and PTH were dominated in all risk groups. (A dominated treatment has a higher cost and poorer outcome.) Treating all eligible women with a bisphosphonate would cost an estimated additional $5563 million (21% total increase) and would result in 390,049 fewer fractures (35% decrease). In the highest risk group, the additional cost of therapy was offset by other healthcare cost savings.
  
  
  CONCLUSIONS
  Osteoporosis treatment of high-risk women is cost-effective, with bisphosphonates providing the most benefit at lowest cost. For highest risk women, costs are offset by savings from fracture prevention.
authors.affiliation: Department of Medicine, Dartmouth Medical School, and The Dartmouth Institute of Health Policy and Clinical Practice (ANAT), Lebanon, NH 03756, USA. anna.tosteson@dartmouth.edu
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: Russel T
authors.initials: RT
authors.lastname: Burge
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Marshall
authors.forename: Robert
authors.initials: R
authors.lastname: Lindsay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000191:economics / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000145:classification / Q000191:economics / Q000627:therapeutic use*; D002017:Budgets / Q000706:statistics & numerical data* / Q000639:trends; D003362:Cost-Benefit Analysis; D004164:Diphosphonates / Q000191:economics / Q000627:therapeutic use*; D012968:Etidronic Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017048:Health Care Costs / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D000077557:Ibandronic Acid; D008390:Markov Chains; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D019057:Quality-Adjusted Life Years; D000068296:Risedronic Acid; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000068296:Risedronic Acid; D012968:Etidronic Acid; D000077557:Ibandronic Acid; D019386:Alendronate