Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations.

OBJECTIVE To evaluate the cost-effectiveness of osteoporosis treatments for women at high fracture risk and estimate the population-level impact of providing bisphosphonate therapy to all eligible high-risk US women. STUDY DESIGN Fractures, healthcare costs, and quality-adjusted life-years (QALYs) were estimated over 10 years using a Markov model. METHODS No therapy, risedronate, alendronate, ibandronate, and teriperatide (PTH) were compared among 4 risk groups. Sensitivity analyses examined the robustness of model results for 65-year-old women with low bone density and previous vertebral fracture. RESULTS Women treated with a bisphosphonate experienced fewer fractures and more QALYs compared with no therapy or PTH. Total costs were lowest for the untreated cohort, followed by risedronate, alendronate, ibandronate, and PTH in all risk groups except women aged 75 years with previous fracture. The incremental cost-effectiveness of risedronate compared with no therapy ranged from cost saving for the base case to $66,722 per QALY for women aged 65 years with no previous fracture. Ibandronate and PTH were dominated in all risk groups. (A dominated treatment has a higher cost and poorer outcome.) Treating all eligible women with a bisphosphonate would cost an estimated additional $5563 million (21% total increase) and would result in 390,049 fewer fractures (35% decrease). In the highest risk group, the additional cost of therapy was offset by other healthcare cost savings. CONCLUSIONS Osteoporosis treatment of high-risk women is cost-effective, with bisphosphonates providing the most benefit at lowest cost. For highest risk women, costs are offset by savings from fracture prevention.

[1]  H. Frost.  Personal Experience in Managing Acute Compression Fractures, their Aftermath, and the Bone Pain Syndrome, in Osteoporosis , 1998, Osteoporosis International.

[2]  T. Powles,et al.  Continued Breast Cancer Risk Reduction in Postmenopausal Women Treated with Raloxifene: 4-Year Results from the MORE Trial , 2004, Breast Cancer Research and Treatment.

[3]  L. Melton,et al.  Cost-effective osteoporosis treatment thresholds: the United States perspective , 2008, Osteoporosis International.

[4]  B. O'brien,et al.  Challenges for Model-Based Economic Evaluations of Postmenopausal Osteoporosis Interventions , 2001, Osteoporosis International.

[5]  E. Brankin,et al.  Treatment persistence with once-monthly ibandronate and patient support vs. once-weekly alendronate: results from the PERSIST study , 2006, International journal of clinical practice.

[6]  J. Reginster,et al.  Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. , 2001, The New England journal of medicine.

[7]  L. Palermo,et al.  Developing better economic models of osteoporosis: considerations for the calculation of the relative risk of fracture. , 2006, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[8]  B. Hillner,et al.  A cost effectiveness analysis of calcium and vitamin D supplementation, etidronate, and alendronate in the prevention of vertebral fractures in women treated with glucocorticoids. , 2003, The Journal of rheumatology.

[9]  B. Ettinger,et al.  Cost-effectiveness of bisphosphonate therapies for women with postmenopausal osteoporosis: implications of improved persistence with less frequently administered oral bisphosphonates , 2007, Current medical research and opinion.

[10]  Kay Dickersin,et al.  Osteoporosis prevention, diagnosis, and therapy. , 2000, NIH consensus statement.

[11]  Robert Kane,et al.  Cost-Effectiveness of Alendronate Therapy for Osteopenic Postmenopausal Women , 2005, Annals of Internal Medicine.

[12]  L. Melton,et al.  Medical Expenditures for the Treatment of Osteoporotic Fractures in the United States in 1995: Report from the National Osteoporosis Foundation , 1997, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[13]  L. Plouffe,et al.  Healthcare use among U.S. women aged 45 and older: total costs and costs for selected postmenopausal health risks. , 1999, Journal of women's health & gender-based medicine.

[14]  W. O'Fallon,et al.  Fracture Incidence in Olmsted County, Minnesota: Comparison of Urban with Rural Rates and Changes in Urban Rates Over time , 1999, Osteoporosis International.

[15]  Mary Jane Geiger,et al.  Effects of Raloxifene on Cardiovascular Events and Breast Cancer in Postmenopausal Women , 2006 .

[16]  E. Barrett-Connor,et al.  Raloxifene and Cardiovascular Events in Osteoporotic Postmenopausal Women: Four-Year Results From the MORE (Multiple Outcomes of Raloxifene Evaluation) Randomized Trial , 2002 .

[17]  P Geusens,et al.  Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. , 2001, The New England journal of medicine.

[18]  P. Saville,et al.  Cost-effectiveness Strategies to Treat Osteoporosis in Elderly Women , 2006, Southern medical journal.

[19]  R. Klein,et al.  The Beaver Dam Health Outcomes study , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[20]  O. Johnell,et al.  Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women , 2004, Osteoporosis International.

[21]  J. Kalmar,et al.  Systematic Review: Bisphosphonates and Osteonecrosis of the Jaws , 2006, Annals of Internal Medicine.

[22]  S. Cummings,et al.  Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. , 2006, JAMA.

[23]  C. Christiansen,et al.  Effects of Oral Ibandronate Administered Daily or Intermittently on Fracture Risk in Postmenopausal Osteoporosis , 2004, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[24]  J. Reginster,et al.  Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. , 2002, The Journal of clinical endocrinology and metabolism.

[25]  H K Genant,et al.  Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. , 1999, JAMA.

[26]  O. Johnell,et al.  The cost-effectiveness of risedronate in the treatment of osteoporosis: an international perspective , 2006, Osteoporosis International.

[27]  S. Cummings,et al.  Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures , 1996, The Lancet.

[28]  R. Wallace,et al.  Costs and health effects of osteoporotic fractures. , 1994, Bone.

[29]  S. Gabriel,et al.  Impact of Hip and Vertebral Fractures on Quality-Adjusted Life Years , 2001, Osteoporosis International.

[30]  M S Calvo,et al.  Prevalence of Low Femoral Bone Density in Older U.S. Adults from NHANES III , 1997, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[31]  R. Josse,et al.  Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 1. Introduction. , 1996, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[32]  R. Kane,et al.  Potential cost-effective use of spine radiographs to detect vertebral deformity and select osteopenic post-menopausal women for amino-bisphosphonate therapy , 2005, Osteoporosis International.

[33]  S Phillips,et al.  The direct medical costs of osteoporosis for American women aged 45 and older, 1986. , 1988, Bone.