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Cost Effectiveness of Alendronate (Fosamax®) for the Treatment of Osteoporosis and Prevention of Fractures

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Abstract

Background: The Fracture Intervention Trial (FIT) demonstrated that the bisphosphonate alendronate reduces the risk of hip, spine and wrist fracture in osteoporotic women by approximately one half.

Objective: To use data from FIT to conduct a cost-effectiveness analysis of alendronate.

Design: A Markov model was developed for a cohort of Swedish women, comparable in relative fracture risk to the women enrolled in the FIT vertebral fracture arm (i.e. age 71 years with low bone mass plus at least one prior spine fracture). The women in the model (with low bone mass and a previous spine fracture) were exposed to alendronate therapy and transitioned over time from a ‘well’ health state to health states of ‘hip fracture’, ‘spine fracture’, ‘wrist fracture’ or ‘death’. All costs were calculated in 2000 Swedish kronors (SEK).

Time horizon: In the Markov model our base-case treatment duration was 5 years followed by a 5-year period where the benefit declined linearly to 0.

Results: We found that treating 71-year-old osteoporotic women with a prior spine fracture with alendronate resulted in a cost per quality-adjusted life-year (QALY) gained of SEK76 000, which is well below the threshold for cost effectiveness of SEK300 000. For women aged 65 years, the cost-effectiveness ratio increased to SEK173 000 and for women aged 77 years, the cost-effectiveness ratio decreased to SEK52 000.

Conclusions: Treating older osteoporotic women with alendronate was more cost effective than treating younger women with osteoporosis, and treating osteoporotic women with prior spine fracture was more cost effective than treating osteoporotic women without prior spine fracture. However, the costs per QALY gained for all populations studied were below generally accepted thresholds for cost effectiveness.

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References

  1. Kanis JA, Melton III LJ, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res 1994; 9: 1137–41

    Article  PubMed  CAS  Google Scholar 

  2. WHO. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical report series. Geneva: World Health Organization, 1994

    Google Scholar 

  3. Ray NF, Chan JK, Thamer M, et al. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997; 12: 24–35

    Article  PubMed  CAS  Google Scholar 

  4. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures: Fracture Intervention Trial Research Group. Lancet 1996; 348: 1535–41

    Article  PubMed  CAS  Google Scholar 

  5. Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280: 2077–82

    Article  PubMed  CAS  Google Scholar 

  6. Goldman L, Garber AM, Grover SA, et al. Task force 6: cost effectiveness of assessment and management of risk factors. J Am Coll Cardiol 1996; 27: 1020–30

    Article  PubMed  CAS  Google Scholar 

  7. Jönsson B, Christiansen C, Johnell O, et al. Cost-effectiveness of fracture prevention in established osteoporosis. Scand J Rheumatol Suppl 1996; 103: 30–8

    Article  PubMed  Google Scholar 

  8. Zethraeus N, Johannesson M, Jönsson B. A computer model to analyse the cost-effectiveness of hormone replacement therapy. Int J Technol Assess Health Care 1999; 15: 352–65

    PubMed  CAS  Google Scholar 

  9. Kanis JA, Johnell O, Odén A, et al. Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 2000; 11: 669–74

    Article  PubMed  CAS  Google Scholar 

  10. US Department of Health and Human Services (DHHS). National Center for Health Statistics. Third National Health and Nutrition Examination Survey, 1988–1994. Hyattsville (MD): Centers for Disease Control and Prevention, 1996

    Google Scholar 

  11. Jönsson B. Targeting high-risk populations. Osteoporos Int 1998; 8 Suppl. 1: S13–6

    PubMed  Google Scholar 

  12. Tonino RP, Meunier PJ, Emkey R, et al. Skeletal benefits of alendronate: 7-year treatment of postmenopausal osteoporotic women. Phase III Osteoporosis Treatment Study Group. J Clin Endocrinol Metab 2000; 85: 3109–15

    Article  PubMed  CAS  Google Scholar 

  13. Ravn P, Bidstrup M, Wasnich RD, et al. Alendronate and estrogen-progestin in the long-term prevention of bone loss: 4-year results from the early postmenopausal intervention cohort study. A randomized, controlled trial. Ann Intern Med 1999; 131: 935–42

    PubMed  CAS  Google Scholar 

  14. Stock JL, Bell NH, Chesnut III CH, et al. Increments in bone mineral density of the lumbar spine and hip and suppression of bone turnover are maintained after discontinuation of alendronate in postmenopausal women. Am J Med 1997; 103: 291–7

    Article  PubMed  CAS  Google Scholar 

  15. McClung M, Clemmesen B, Daifotis A, et al. Alendronate prevents postmenopausal bone loss in women without osteoporosis: a double-blind, randomized, controlled trial. Alendronate Osteoporosis Prevention Study Group. Ann Intern Med 1998; 128: 253–61

    PubMed  CAS  Google Scholar 

  16. Zethraeus N, Strömberg L, Jönsson B, et al. The cost of a hip fracture. Acta Orthop Scand 1997; 68: 13–7

    Article  PubMed  CAS  Google Scholar 

  17. The Swedish drug compendium. Stockholm: Linfo Läkemedelsinformation AB, 2000

  18. Statistical Year Book Sweden. Stockholm: Statistiska Centralbyrån, 2000: 86

  19. Weinstein MC. Estrogen use in postmenopausal women: costs, risks, and benefits. N Engl J Med 1980; 303: 308–16

    Article  PubMed  CAS  Google Scholar 

  20. Hillner BE, Hollenberg JP, Pauker SG. Postmenopausal estrogens in prevention of osteoporosis: benefit virtually without risk if cardiovascular effects are considered. Am J Med 1986; 80: 1115–27

    Article  PubMed  CAS  Google Scholar 

  21. Zethraeus N, Borgström F, Johnell O, et al. Costs and quality of life associated with osteoporosis related fractures — results from a Swedish survey. Working paper 512, Stockholm School of Economics. Available from URL: http://swopec.hhs.se/hastef/abs/hastef0512.htm [Accessed 2003 Feb 20]

  22. National Osteoporosis Foundation. Osteoporosis: cost-effectiveness analysis and review of the evidence for prevention, diagnosis and treatment. Osteoporosis Int 1998; 8 Suppl. 4: S1–88

    Article  Google Scholar 

  23. Dolan P, Torgerson D, Kakarlapudi TK. Health-related quality of life of Colles’ fracture patients. Osteoporos Int 1999; 9: 196–9

    Article  PubMed  CAS  Google Scholar 

  24. Torgerson DJ, Reid DM. The economics of osteoporosis and its prevention: a review. Pharmacoeconomics 1997; 11: 126–38

    Article  PubMed  CAS  Google Scholar 

  25. Meunier PJ. Evidence-based medicine and osteoporosis: a comparison of fracture risk reduction data from osteoporosis randomised clinical trials. Int J Clin Pract 1999; 53: 122–9

    PubMed  CAS  Google Scholar 

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Acknowledgements

Financial support was obtained from Merck Sharp & Dohme (Sweden) AB. The authors have provided no information on conflicts of interest directly relevant to the content of this study.

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Johnell, O., Jönsson, B., Jönsson, L. et al. Cost Effectiveness of Alendronate (Fosamax®) for the Treatment of Osteoporosis and Prevention of Fractures. Pharmacoeconomics 21, 305–314 (2003). https://doi.org/10.2165/00019053-200321050-00002

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