Cost effectiveness of multi-therapy treatment strategies in the prevention of vertebral fractures in postmenopausal women with osteoporosis

• Published in: PharmacoEconomics 1998-11, Vol.14 (5), p.559-573
• Main Authors: Rosner, A J, Grima, D T, Torrance, G W, Bradley, C, Adachi, J D, Sebaldt, R J, Willison, D J
• Format: Article
• Language: English
• Subjects: Aged; Alendronate - economics; Alendronate - therapeutic use; Alendronic-acid; Calcium; Calcium - economics; Calcium - therapeutic use; Cost-Benefit Analysis; Cost-effectiveness; Cost-utility; Drug Therapy, Combination; Estradiol; Estradiol - economics; Estradiol - therapeutic use; Estrogen Replacement Therapy - economics; Estrogens; Estrogens - economics; Estrogens - therapeutic use; Etidronic Acid - economics; Etidronic Acid - therapeutic use; Etidronic-acid; Female; Health technology assessment; Humans; Menopause; Middle Aged; Osteoporosis, Postmenopausal - complications; Osteoporosis, Postmenopausal - economics; Osteoporosis-therapies; Pharmacoeconomics; Postmenopausal-osteoporosis; Quality-Adjusted Life Years; Retrospective Studies; Sensitivity and Specificity; Spinal Fractures - economics; Spinal Fractures - etiology; Spinal Fractures - prevention & control; Vertebral-fracture
• ISSN: 1170-7690; 1179-2027
• DOI: 10.2165/00019053-199814050-00007

The aim of this study was to evaluate the cost effectiveness of multi-therapy treatment strategies in the prevention of vertebral fractures in postmenopausal women with osteoporosis. A retrospective, incremental cost-effectiveness analysis was conducted from a societal perspective. It compared 9 treatment strategies over 3 years and incorporated the willingness of patients to initiate and continue each therapy. Four nondominated strategies formed the efficient frontier in the following order: (i) calcium-->no therapy; (ii) ovarian hormone therapy (OHT)-->calcium-->no therapy [166 Canadian dollars ($Can)]; (iii) OHT-->etidronate-->calcium-->no therapy ($Can2331); and (iv) OHT-->alendronate-->calcium-->no therapy ($Can40,965). The figures in parentheses are the incremental costs per vertebral fracture averted to move to that strategy from the previous strategy for patients who had undergone a hysterectomy. We identified 4 efficient multi-therapy strategies for the treatment of vertebral osteoporosis in postmenopausal women, 2 of which were consistent with the practice guidelines of the Osteoporosis Society of Canada. Decision-makers may select from among these efficient strategies on the basis of incremental cost effectiveness.