Cost-Effectiveness of Zoledronic Acid to Prevent and Treat Postmenopausal Osteoporosis in Comparison with Routine Medical Treatment.
BACKGROUND
Fractures caused by osteoporosis are prevalent among elderly females, which reduce quality of life significantly. This study aimed at comparing cost-effectiveness of Zoledronic acid in preventing and treating post-menopause osteoporosis as compared with routine medical treatment.


METHODS
This cost-effectiveness study was carried out retrospectively from the Ministry of Health and insurance organizations perspective. Costs were evaluated based on the cost estimation of a sample of patients. Outcomes were obtained from a systematic review. The Cost-Effectiveness Ratio (CER) and incremental cost-effectiveness ratio (ICER) for outcome of femoral neck Bone Mineral Density (BMD), hip trochanter BMD, total hip BMD and lumbar spine BMD and cost-benefit of consuming Zoledronic Acid were calculated for fracture outcome obtained from reviewing hospital records.


RESULTS
The results and the ICER calculated for study outcomes indicated that one percent increase of BMD on femoral neck BMD requires further cost of $386. One percent increase of BMD on hip trochanter BMD requires further cost of $264. One percent increase of BMD on total hip BMD requires further cost of $388, one percent increase of BMD on lumbar spine BMD requires further cost of $347. The Cost Benefit Analysis (CBA) calculated for vertebral and hip fracture, non-vertebral fracture, any clinical fracture, and morphometric fracture for a 36-month period were about 0.82, 0.57, and 1.06, respectively. Vertebral and hip fractures, and non-vertebral fractures or any clinical fracture for a 12-month period were calculated as 1.14 and 0.64, respectively. In other words, Zoledronic acid consumption approach is a cheaper and better approach based on an economic assessment, and it can be considered as a dominant approach.


CONCLUSIONS
According to the cost-effectiveness of zoledronic acid in the prevention and treatment of osteoporosis in women, despite the costs, it is recommended that insurance coverage for the drug should be considered in the period after menopause and the benefits of this drug. This can reduce the costs imposed on the patients and also it can reduce the economic burden on the community, particularly as a result of the fracture.
M.Sc. in Health Economics, Department of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
Fateme Rostami
FR
Golmohamdi
Associate Professor of Rheumatology, Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
Mahnaz
M
Abbasi
Ph.D. Student in Health Economics, Department of Public Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Ali Kazemi
AK
Karyani
Ph.D. of Health Policy, Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Ali Akbari
AA
Sari
Cost-benefit; Cost-effectiveness; Osteoporosis; Postmenopausal; Zoledronic acid