title: Cost-effectiveness of dual-energy X-ray absorptiometry plus antiresorptive treatment in Australian women with breast cancer who receive aromatase inhibitors.
abstract: Postmenopausal women with breast cancer on aromatase inhibitor (AI) treatment are at increased risk of bone mineral density loss, which may lead to minimal trauma fractures. We examined the cost-effectiveness of dual energy X-ray absorptiometry (DXA) with antiresorptive (AR) therapy compared with fracture risk assessment, lifestyle advice, and vitamin supplementation. We used a hypothetical Markov cohort model of lifetime duration for 60-year-old women with early stage breast cancer receiving AIs. The data to inform the model came from medical literature, epidemiological reports, and costing data sets. Two eligibility scenarios for AR therapy were considered: (A) osteoporosis and (B) osteopenia or osteoporosis. The main outcomes were incremental cost per quality-adjusted life years gained and cumulative fractures per 1000 women, calculated relative to the comparator. Key aspects of the model were explored in sensitivity analyses. Due to relatively low effectiveness gains, the outcomes were primarily driven by the costs. The incremental cost per quality-adjusted life year gained was A$47,556 and A$253,000 for scenarios A and B, respectively. The numbers of fractures avoided were 56 and 77 per 1000 women, respectively. The results were most sensitive to the initial probability of osteoporosis, baseline risk of fracture, and cohort starting age. Compared with risk assessment and lifestyle advice only, a DXA scan followed by an AR treatment is potentially cost-effective for women aged 60 and over undergoing AI therapy for early breast cancer. However, the number of fractures averted through this intervention is small.
authors.affiliation: Research School of Population Health, Australian National University, Acton, ACT, 2601, Australia. m.sowa@anu.edu.au.
authors.forename: P Marcin
authors.identifier: http://orcid.org/0000-0001-8892-4133
authors.initials: PM
authors.lastname: Sowa
authors.affiliation: Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, 4131, Australia.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Downes
authors.affiliation: Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, 4131, Australia.
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Gordon
mesh_terms: D015502:Absorptiometry, Photon / Q000191:economics*; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001315:Australia; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000191:economics* / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D001943:Breast Neoplasms / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D019057:Quality-Adjusted Life Years
chemical_list: D047072:Aromatase Inhibitors; D050071:Bone Density Conservation Agents
keywords: Antiresorptive therapy; Aromatase inhibitors; Cost-effectiveness; Dual-energy X-ray absorptiometry; Markov model