Cost-Effectiveness of Osteoporosis Screening and Treatment with Hormone Replacement Therapy, Raloxifene, or Alendronate

Recent information about osteoporosis treatments and their nonfracture side effects suggests the need for a new costeffectiveness analysis. The authors estimate the cost effectiveness of screening women for osteoporosis at age 65 and treating those who screen positive with hormone replacement therapy (HRT), raloxifene, or alendronate. A Markov model of osteoporosis disease progression simulates costs and outcomes of women aged 65 years. Incremental cost effectiveness ratios of screen-and-treat strategies are calculated relative to a no-screen, no-treat (NST) strategy. Disease progression parameters are derived from clinical trials; cost and quality-of-life parameters are based on review of cost databases and cost-effectiveness studies. Women are screened using dual-energy x-ray absorptiometry, and women screening positive are treated with HRT, raloxifene, or alendronate. Screening and treatment with HRT increase costs and lower quality-adjusted life years (QALYs; relative to the NST strategy). The only scenario (of several) in the sensitivity analysis in which HRT increases QALYs is when it is assumed that there are no drug-related (nonfracture) health effects. Raloxifene increases costs and QALYs; its cost-effectiveness ratio is $447,559 per QALY. When prescribed for the shortest duration modeled, raloxifene’s cost-effectiveness ratio approached $133,000 per QALY. Alendronate is the most cost-effective strategy; its cost-effectiveness ratio is $72,877 per QALY. Alendronate’s cost-effectiveness ratio approaches $55,000 per QALY when treatment effects last for 5 years or the discount rate is set to zero. The authors conclude that screening and treating with alendronate are more costeffective than screening and treating with raloxifene or HRT. Relative to an NST strategy, alendronate has a fairly good cost-effectiveness ratio