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Cost-effectiveness strategies to treat osteoporosis in elderly women
Alfred K Pfister1, Christine A Welch, Melissa D Lester
1Department of Medicine, West Virginia University School of Medicine, Charleston 25304, USA. apfister@hcs.wvu.edu
Background:
Comparing the cost-effectiveness of various antiosteoporotic drugs has not been defined.
Methods:
We determined the cost-effectiveness of calcitonin, raloxifene, bisphosphates and PTH in a base-case cohort of women aged 65 or older with osteoporosis. After bone densitometry, women were stratified into groups of treatment or no treatment. Our outcome goal was a value of dollars 100,000 or less per quality-adjusted life years (QALY). A sensitivity analysis varied nonvertebral fracture reduction and compliance between the two most effective strategies to test various cost per QALY thresholds.
Results:
Bisphosphonates displayed the most favorable incremental cost saving and prevented more fractures in our base-case analysis. In a sensitivity analysis, virtually all values of bisphosphonates were under dollars 100,000 per QALY and parathyroid hormone (PTH) was between dollars 100,000 and dollars 200,000 per QALY.
Conclusions:
Only bisphosphonates are cost-effective for fracture prevention in osteoporotic women aged 65 or older and this economic advantage is also maintained in subsets who have a lower relative risk of future fracture.
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