title: Cost-effectiveness of osteoporosis treatments in postmenopausal women using FRAX™ thresholds for decision.
abstract: OBJECTIVE
  FRAX™ is a fracture prediction algorithm to determine a patient's absolute fracture risk. There is a growing consensus that osteoporosis treatment should be based on individual 10-year fracture probability, as calculated in the FRAX™ algorithm, rather than on T-scores alone.
  
  
  OBJECTIVE
  Our objective was to evaluate the cost-effectiveness of five years of branded alendronate therapy in postmenopausal French women with a known FRAX™ score.
  
  
  METHODS
  A Markov cohort state transition model using FRAX™ values and whenever possible population-specific data and probabilities. We estimated the incremental cost-effectiveness ratio (ICER) of alendronate versus no treatment in postmenopausal women with FRAX™ ranging from 10 to 3%.
  
  
  RESULTS
  Number of women to treat (NNT) for preventing hip fracture, costs, quality-adjusted life-years, incremental cost-effectiveness ratios.
  
  
  RESULTS
  The incremental cost-effectiveness ratios (ICER) compared to no treatment at age 70 ranged from €104,183 to €413,473 per QALY when FRAX™ decreased from 10 to 3%. The NNTs for preventing one hip fracture ranged from 97 to 388 according to age (50-80 years) and FRAX™. Sensitivity analyses showed that the main determinants of cost-effectiveness were adherence to therapy and cost of treatment.
  
  
  CONCLUSIONS
  Using French costs of branded drug and current estimates of treatment efficacy, alendronate therapy for 70-year-old women with 10-year probability of hip fracture of 10% just meets the accepted cost-effectiveness threshold. Improving treatment adherence and/or decreasing treatment cost lowers the ICER. The model however underestimates the potential benefit by excluding other fractures.
authors.affiliation: Paris health economics and health services research unit (URC Eco Ile de France), AP-HP, 75010 Paris, France.
authors.forename: Kazem
authors.initials: K
authors.lastname: Alzahouri
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bahrami
authors.forename: Isabelle
authors.initials: I
authors.lastname: Durand-Zaleski
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
authors.forename: Christian
authors.initials: C
authors.lastname: Roux
mesh_terms: D000368:Aged; D019386:Alendronate / Q000191:economics / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D006620:Hip Fractures / Q000517:prevention & control; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D018570:Risk Assessment
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate