MINNEAPOLIS, Minnesota—The first cost-effectiveness study to include the cost of bisphosphonate therapy and to make allowances for the usual drop-off in adherence after the first year of treatment has concluded that general screening of men 70 or older followed by bisphosphonate treatment for those with osteoporosis is unlikely to be a cost-effective strategy for preventing osteoporotic fracture. The computer Markov microsimulation model reported in the Journal of the American Medical Association by John T. Schousboe, MD, MS, at the University of Minnesota, et al does suggest that screening and treatment would be cost-effective for men age 65 or older with prior fracture and for all men of 80 or older.¹

The researchers also point out that screening and treatment of older men will likely become more cost effective as generic bisphophonates become available. "Since alendronate [Fosamax®, Merck & Co, Inc] will lose patent protection in the United States in 2008, the cost of oral bisphosphonate therapy in the near future may be much less than the current average US wholesale price," Dr. Schousboe says.

Computer simulations of treatment effect on fracture risk in men 65 to 85

The team performed computer simulations for hypothetical cohorts of white men ages 65, 70, 75, 80, or 85, with or without prior clinical fracture. Data for the simulations came from the Rochester Epidemiology Project, the Osteoporotic Fractures in Men (MrOS) study, published meta-analyses for associations among prior fractures, bone density, and incident fractures, and published studies of fracture disutility. The main outcome measure was costs per quality-adjusted life-year (QALY) gained with screening and treatment versus no intervention. Among health planners, a QALY of $50,000 is often used as a benchmark for "reasonable" societal cost of a proposed intervention.

According to Dr. Schousboe, the analysis showed costs per QALY gained would be:

• $129,665-$66,071 for men age 65-75 with no prior fracture
  
• $47,537 for men age 65 with prior fracture
  
• $35,037 for men age 70 with prior fracture
  
• $23,260 for men age 75 with prior fracture
  
• $45,587 for men age 80 with no prior fracture, but only  $15,477 for those with prior fracture, and
• $33,666 for men age 85 with no prior fracture, but $4,700 for those with prior fracture.

The estimated osteoporosis prevalence ranged from 14.5% (age 65) to 33.6% (age 85) in those with prior fracture but was only 7.6% (age 65) to 17.6% (age 85) in those without fracture.

"The densitometry and treatment strategy modestly reduced the absolute 10-year incidence of clinical fracture by a range of 2.1% for 65-year-old men without a prior fracture to 4.5% among 85-year-old men with a prior fracture," the investigators report.

Dr. Schousboe concludes, "Bone densitometry followed by bisphosphonate therapy for those with osteoporosis may be cost-effective for men aged 65 years or older with a self-reported prior clinical fracture and for men aged 80 to 85 years with no prior fracture. This strategy may also be cost-effective for men as young as 70 years without a prior clinical fracture if oral bisphosphonate costs are less than $500 per year or if the societal willingness to pay per QALY gained is $100,000."

Reference