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

Author

Listed:
  • Lee R. Mobley

    (Division for Health Services and Social Policy Research, RTI International (Research Triangle Institute), 3040 Cornwallis Road, Research Triangle Park, NC 27709 lmobley@rti.org)

  • Thomas J. Hoerger
  • John S. Wittenborn

    (RTI International, Research Triangle Park, North Carolina)

  • Deborah A. Galuska
  • Jaya K. Rao

    (Centers for Disease Control and Prevention, Atlanta, Georgia)

Abstract

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

Suggested Citation

  • Lee R. Mobley & Thomas J. Hoerger & John S. Wittenborn & Deborah A. Galuska & Jaya K. Rao, 2006. "Cost-Effectiveness of Osteoporosis Screening and Treatment with Hormone Replacement Therapy, Raloxifene, or Alendronate," Medical Decision Making, , vol. 26(2), pages 194-206, March.
    • Handle: RePEc:sae:medema:v:26:y:2006:i:2:p:194-206
    DOI: 10.1177/0272989X06286478
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    Citations

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    Cited by:

    1. Björn Stollenwerk & Afschin Gandjour & Markus Lüngen & Uwe Siebert, 2013. "Accounting for increased non-target-disease-specific mortality in decision-analytic screening models for economic evaluation," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(6), pages 1035-1048, December.
    2. Smita Nayak & Mark S Roberts & Susan L Greenspan, 2012. "Impact of Generic Alendronate Cost on the Cost-Effectiveness of Osteoporosis Screening and Treatment," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-7, March.
    3. Rachael Fleurence & Cynthia Iglesias & Jeanene Johnson, 2007. "The Cost Effectiveness of Bisphosphonates for the Prevention and Treatment of Osteoporosis," PharmacoEconomics, Springer, vol. 25(11), pages 913-933, November.
    4. Dirk Mueller & Afschin Gandjour, 2011. "Cost effectiveness of secondary vs tertiary prevention for post-menopausal osteoporosis," Applied Health Economics and Health Policy, Springer, vol. 9(4), pages 259-273, July.

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