[Use of alendronate in osteoporosis--is it cost-effective?]

The objective of the analysis was to establish the cost-effectiveness of five years intervention with alendronate in women aged 65 years with a bone mineral density (BMD) of the femoral neck 2.5 SD below peak bone mass. A cost-utility analysis based on a simulation model was used. The risk of future fractures was estimated on the basis of clinical and epidemiologic data. The costs of intervention and of fracture treatment were based on market prices (measurement of BMD), the Norwegian DRG price list (in-patient hospital care), the pay scale of the Norwegian Medical Association (out-patient care, doctor's visits, laboratory tests, radiographs), public accounts (nursing home care, rehabilitation) and customary charges (transport, physiotherapy etc.). The discounted cost per Quality Adjusted Life Year (QALY) was NOK 528,000, NOK 291,000 and NOK 147,000 when BMD was respectively 1.5, 2.5 and 3.5 SD below peak bone masa at onset of intervention. Sensitivity analyses indicate that the cost per QALY is relatively sensitive to future risk of fracture, cost of intervention, discount rate, and magnitude and duration of the effects of the intervention. The results indicate that the use of alendronate competes favourably with other commonly used preventive programmes when administered to women with high risk of fragility fractures.