The impact of fewer hip fractures with risedronate versus alendronate in the first year of treatment: modeled German cost-effectiveness analysis.
BACKGROUND
The Risedronate and Alendronate (REAL) cohort study provides unique comparative effectiveness data for real world bisphosphonate treatment of osteoporosis.


OBJECTIVE
The objective of this analysis was to assess the cost-effectiveness of risedronate compared to generic alendronate in Germany applying the REAL effectiveness data.


METHODS
A validated Markov model of osteoporosis was populated with REAL effectiveness data and German epidemiological, cost, and utility data. To estimate the impact of therapy on hip fractures, costs, and quality adjusted life years (QALYs), the analysis included women>or=65 years, treated with risedronate or alendronate and followed for 4 additional years. Country-specific data included population mortality, fracture costs, and annual drug costs, using a German social insurance perspective. Costs and outcomes were discounted at 3%. A differential hip fracture relative risk reduction of 43% was applied to risedronate vs. alendronate.


RESULTS
The model predicted that treatment with risedronate would result in fewer hip fractures and more QALYs at a reduced cost (savings of euro278 per treated woman) compared to treatment with generic alendronate. Sensitivity analysis assuming 2 years of treatment and equivalence of effect after 1 year show cost savings as well (euro106 per treated woman).


CONCLUSIONS
Whereas previous economic evaluations involving bisphosphonates have mainly relied on efficacy data from noncomparative clinical trials, this study's strength is in the use of comparative effectiveness data from one data source. The magnitude of the cost savings observed were sensitive to alternative assumptions regarding treatment duration, therapy discontinuation and cost of generic alendronate.


CONCLUSIONS
Based on "real world" data the analysis supports the first line use of risedronate for the treatment of osteoporotic women in Germany.
Thompson
Melissa
M
Cornerstone Research Group Inc., Burlington, Ontario, Canada. mthompson@cornerstone-research.com
Pasquale
Margaret
M
Grima
Daniel
D
Moehrke
Werner
W
Kruse
Hans Peter
HP
D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000191:economics* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany / Q000453:epidemiology; D006620:Hip Fractures / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008390:Markov Chains; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000191:economics / Q000473:pathology; D019057:Quality-Adjusted Life Years; D020849:Raloxifene Hydrochloride / Q000191:economics* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D050071:Bone Density Conservation Agents; D020849:Raloxifene Hydrochloride; D019386:Alendronate