Dirk Mueller (Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany) Eva Weyler (Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany) Afschin Gandjour (Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany)
Abstract
Background: The German osteology umbrella organization, Dachverband Osteologie (DVO), has published a new guideline for the secondary prevention of osteoporotic fractures. According to the guideline, women are screened using dual x-ray absorptiometry (DXA). Those with an absolute 10-year fracture risk >=30% are treated with bisphosphonates such as alendronate or risedronate for 4 years or with teriparatide for 18 months. Objective: To determine the cost effectiveness of the screen-and-treat strategy versus no intervention in women of the general population aged 50-90 years in Germany. Methods: Cost-utility and budget-impact analyses were performed from the perspective of the statutory health insurance (SHI). A Markov model with a 1-year cycle length simulated costs and benefits (QALYs), discounted at 3%, over a lifetime horizon. The number of women correctly diagnosed by pre-tests and DXA as having a 10-year fracture risk of >=30% was estimated for different age groups (50-60, 60-70, 70-80 and 80-90 years). Incremental cost-effectiveness ratios (ICERs) were calculated; all costs are presented in _, year 2006 values. Robustness of the results was tested by a probabilistic Monte Carlo simulation. Results: Alendronate was the most cost-effective drug in all age groups; the ICERs were _3849, _16_589, _6600 and _2337 per QALY for 50-, 60-, 70- and 80-year-old women, respectively, followed by risedronate. Teriparatide was dominated in every age group. Implementing the screen-and-treat strategy would result in annual costs of _175 million for alendronate (_181 million for risedronate) or 0.14% of the SHI annual budget. Results were robust in the sensitivity analysis. Conclusion: While the screen-and-treat strategy would result in a substantial cost increase for the SHI, the use of alendronate within such a strategy appears cost effective when compared with many generally accepted medical interventions.
Download Info
To download:
If you experience problems downloading a file, check if you have the
proper application to
view it first. Information about this may be contained
in the File-Format links below. In case of further problems read
the IDEAS help
file. Note that these files are not on the IDEAS
site. Please be patient as the files may be large.
As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
Publisher Info
Article provided by Wolters Kluwer Health | Adis in its journal PharmacoEconomics.
Volume (Year): 26 (2008) Issue (Month): 6 () Pages: 513-536 Download reference. The following formats are available: HTML,
plain text,
BibTeX,
RIS (EndNote),
ReDIF
Find related papers by JEL classification: C - Mathematical and Quantitative Methods D - Microeconomics I - Health, Education, and Welfare Z - Other Special Topics I1 - Health, Education, and Welfare - - Health I19 - Health, Education, and Welfare - - Health - - - Other I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets