This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (4) Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Mobley, L. R. Articles by Rao, J. K. Search for Related Content PubMed PubMed Citation Articles by Mobley, L. R. Articles by Rao, J. K. Social Bookmarking                   What's this?

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

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

Thomas J. Hoerger, PhD

John S. Wittenborn, BS

RTI International, Research Triangle Park, North Carolina

Deborah A. Galuska, MPH, PhD

Jaya K. Rao, MD, MHS

Centers for Disease Control and Prevention, Atlanta, Georgia

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

Key Words: osteoporosis • hormone replacement therapy • raloxifene • alendronate

Medical Decision Making, Vol. 26, No. 2, 194-206 (2006)
DOI: 10.1177/0272989X06286478


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				F.-E. Cotte, B. Fautrel, and G. De Pouvourville A Markov Model Simulation of the Impact of Treatment Persistence in Postmenopausal Osteoporosis Med Decis Making, January 1, 2009; 29(1): 125 - 139. [Abstract] [PDF]

				J L. Veerman and T. Vos Confusion from analyses and conflicts of interest BMJ, November 25, 2008; 337(nov25_1): a2683 - a2683. [Full Text]

				G. A. Zarkin, J. W. Bray, A. Aldridge, D. Mitra, M. J. Mills, D. J. Couper, R. A. Cisler, and for the COMBINE Cost-Effectiveness Research Group Cost and Cost-effectiveness of the COMBINE Study in Alcohol-Dependent Patients Arch Gen Psychiatry, October 1, 2008; 65(10): 1214 - 1221. [Abstract] [Full Text] [PDF]

				M. Helfand and L. Saxton Medical Decision Making and Electronic Publishing Med Decis Making, March 1, 2007; 27(2): 98 - 100. [PDF]

				E. S. Meadows, J. Stock, and J. A. Johnston Commentary on Mobley and Others: Importance of Assumptions About VTE Mortality in Modeling the Cost-effectiveness of Osteoporosis Therapies Med Decis Making, November 1, 2006; 26(6): 633 - 635. [PDF]