Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women

Background: Treatment guidelines recommend drug treatment to prevent fractures for some postmenopausal women who have low bone mass (osteopenia) but do not have osteoporosis or a history of clinical fractures. Objective: To estimate the societal costs and health benefits of alendronate drug treatment to prevent fractures in postmenopausal women with osteopenia. Design: Markov model with 8 health states: no fracture, post-distal forearm fracture, post-clinical vertebral fracture, post-radiographic (but clinically inapparent) vertebral fracture, post-hip fracture, post-hip and vertebral fractures, post-other fracture, and death. Data Sources: Population-based studies of age-specific fracture rates and costs, prospectively measured estimates of disutility after fractures, and the Fracture Intervention Trial of alendronate versus placebo to prevent fracture. Target Population: Postmenopausal women 55 to 75 years of age with femoral neck T-scores between -1.5 and -2.4. Time Horizon: Lifetime. Perspective: Societal. Interventions: Five years of alendronate therapy or no drug treatment. Outcome Measures: Costs, quality-adjusted life-years, and incremental cost-effectiveness ratios. Results of Base-Case Analysis: For women with no additional fracture risk factors, the cost per quality-adjusted life-year gained ranged from $70 000 to $332 000, depending on age and femoral neck bone density. Results of Sensitivity Analyses: Results were sensitive to changes in fracture risk reduction attributable to alendronate and alendronate cost. Limitations: Results apply only to postmenopausal white women residing in the United States. Conclusion: Alendronate therapy for postmenopausal women with femoral neck T-scores better than -2.5 and no history of clinical fractures or other bone mineral density-independent risk factors for fracture is not cost-effective, assuming U.S. costs of alendronate and currently available estimates of alendronate efficacy in osteopenic women.