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Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations.
Am J Manag Care. 2008 Sep; 14(9):605-15.AJ

Abstract

OBJECTIVE

To evaluate the cost-effectiveness of osteoporosis treatments for women at high fracture risk and estimate the population-level impact of providing bisphosphonate therapy to all eligible high-risk US women.

STUDY DESIGN

Fractures, healthcare costs, and quality-adjusted life-years (QALYs) were estimated over 10 years using a Markov model.

METHODS

No therapy, risedronate, alendronate, ibandronate, and teriperatide (PTH) were compared among 4 risk groups. Sensitivity analyses examined the robustness of model results for 65-year-old women with low bone density and previous vertebral fracture.

RESULTS

Women treated with a bisphosphonate experienced fewer fractures and more QALYs compared with no therapy or PTH. Total costs were lowest for the untreated cohort, followed by risedronate, alendronate, ibandronate, and PTH in all risk groups except women aged 75 years with previous fracture. The incremental cost-effectiveness of risedronate compared with no therapy ranged from cost saving for the base case to $66,722 per QALY for women aged 65 years with no previous fracture. Ibandronate and PTH were dominated in all risk groups. (A dominated treatment has a higher cost and poorer outcome.) Treating all eligible women with a bisphosphonate would cost an estimated additional $5563 million (21% total increase) and would result in 390,049 fewer fractures (35% decrease). In the highest risk group, the additional cost of therapy was offset by other healthcare cost savings.

CONCLUSIONS

Osteoporosis treatment of high-risk women is cost-effective, with bisphosphonates providing the most benefit at lowest cost. For highest risk women, costs are offset by savings from fracture prevention.

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Authors+Show Affiliations

Tosteson AN
Department of Medicine, Dartmouth Medical School, and The Dartmouth Institute of Health Policy and Clinical Practice (ANAT), Lebanon, NH 03756, USA. anna.tosteson@dartmouth.edu
Burge RT
No affiliation info available
Marshall DA
No affiliation info available
Lindsay R
No affiliation info available

MeSH

AgedAged, 80 and overAlendronateBone Density Conservation AgentsBudgetsCost-Benefit AnalysisDiphosphonatesEtidronic AcidFemaleFractures, BoneHealth Care CostsHumansIbandronic AcidMarkov ChainsOsteoporosis, PostmenopausalQuality-Adjusted Life YearsRisedronic AcidRisk AssessmentRisk FactorsUnited States

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18778176

Citation

Tosteson, Anna N A., et al. "Therapies for Treatment of Osteoporosis in US Women: Cost-effectiveness and Budget Impact Considerations." The American Journal of Managed Care, vol. 14, no. 9, 2008, pp. 605-15.
Tosteson AN, Burge RT, Marshall DA, et al. Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations. Am J Manag Care. 2008;14(9):605-15.
Tosteson, A. N., Burge, R. T., Marshall, D. A., & Lindsay, R. (2008). Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations. The American Journal of Managed Care, 14(9), 605-15.
Tosteson AN, et al. Therapies for Treatment of Osteoporosis in US Women: Cost-effectiveness and Budget Impact Considerations. Am J Manag Care. 2008;14(9):605-15. PubMed PMID: 18778176.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations. AU - Tosteson,Anna N A, AU - Burge,Russel T, AU - Marshall,Deborah A, AU - Lindsay,Robert, PY - 2008/9/10/pubmed PY - 2008/9/30/medline PY - 2008/9/10/entrez SP - 605 EP - 15 JF - The American journal of managed care JO - Am J Manag Care VL - 14 IS - 9 N2 - OBJECTIVE: To evaluate the cost-effectiveness of osteoporosis treatments for women at high fracture risk and estimate the population-level impact of providing bisphosphonate therapy to all eligible high-risk US women. STUDY DESIGN: Fractures, healthcare costs, and quality-adjusted life-years (QALYs) were estimated over 10 years using a Markov model. METHODS: No therapy, risedronate, alendronate, ibandronate, and teriperatide (PTH) were compared among 4 risk groups. Sensitivity analyses examined the robustness of model results for 65-year-old women with low bone density and previous vertebral fracture. RESULTS: Women treated with a bisphosphonate experienced fewer fractures and more QALYs compared with no therapy or PTH. Total costs were lowest for the untreated cohort, followed by risedronate, alendronate, ibandronate, and PTH in all risk groups except women aged 75 years with previous fracture. The incremental cost-effectiveness of risedronate compared with no therapy ranged from cost saving for the base case to $66,722 per QALY for women aged 65 years with no previous fracture. Ibandronate and PTH were dominated in all risk groups. (A dominated treatment has a higher cost and poorer outcome.) Treating all eligible women with a bisphosphonate would cost an estimated additional $5563 million (21% total increase) and would result in 390,049 fewer fractures (35% decrease). In the highest risk group, the additional cost of therapy was offset by other healthcare cost savings. CONCLUSIONS: Osteoporosis treatment of high-risk women is cost-effective, with bisphosphonates providing the most benefit at lowest cost. For highest risk women, costs are offset by savings from fracture prevention. SN - 1936-2692 UR - https://www.unboundmedicine.com/medline/citation/18778176/Therapies_for_treatment_of_osteoporosis_in_US_women:_cost_effectiveness_and_budget_impact_considerations_ L2 - https://www.ajmc.com/pubMed.php?pii=10710 DB - PRIME DP - Unbound Medicine ER -