title: Impact of generic alendronate cost on the cost-effectiveness of osteoporosis screening and treatment.
abstract: BACKGROUND
  Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women.
  
  
  METHODS
  Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorptiometry (DXA), and alendronate treatment for individuals with osteoporosis; with a comparator of "no screening" and treatment only after fracture occurrence. We evaluated annual alendronate costs of $20 through $800; outcome measures included fractures; nursing home admission; medication adverse events; death; costs; quality-adjusted life-years (QALYs); and incremental cost-effectiveness ratios (ICERs) in 2010 U.S. dollars per QALY gained. A lifetime time horizon was used, and direct costs were included. Base-case and sensitivity analyses were performed.
  
  
  RESULTS
  Base-case analysis results showed that at annual alendronate costs of $200 or less, osteoporosis screening followed by treatment was cost-saving, resulting in lower total costs than no screening as well as more QALYs (10.6 additional quality-adjusted life-days). When assuming alendronate costs of $400 through $800, screening and treatment resulted in greater lifetime costs than no screening but was highly cost-effective, with ICERs ranging from $714 per QALY gained through $13,902 per QALY gained. Probabilistic sensitivity analyses revealed that the cost-effectiveness of osteoporosis screening followed by alendronate treatment was robust to joint input parameter estimate variation at a willingness-to-pay threshold of $50,000/QALY at all alendronate costs evaluated.
  
  
  CONCLUSIONS
  Osteoporosis screening followed by alendronate treatment is effective and highly cost-effective for postmenopausal women across a range of alendronate costs, and may be cost-saving at annual alendronate costs of $200 or less.
authors.affiliation: Section of Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America. nayaks@upmc.edu
authors.forename: Smita
authors.initials: S
authors.lastname: Nayak
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
authors.forename: Susan L
authors.initials: SL
authors.lastname: Greenspan
mesh_terms: D015502:Absorptiometry, Photon / Q000191:economics; D000368:Aged; D019386:Alendronate / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000379:methods*; D016568:Drugs, Generic / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D018803:Models, Economic; D010024:Osteoporosis / Q000175:diagnosis* / Q000188:drug therapy*; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
chemical_list: D016568:Drugs, Generic; D019386:Alendronate