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Alendronate Cost-Effective In Elderly Men With Low Bone Mass and Previous Vertebral Fractures

For elderly men with low bone mass and prior vertebral fractures, treatment with alendronate is projected to be cost-effective based on the assumption that the reduction in fracture risk associated with alendronate in women is comparable in men, reports a study from Sweden.

Alendronate has been shown to reduce the risk of fracture and increase bone density in women and men, but the cost-effectiveness of alendronate only has been shown for women.

In this study, Fredrik Borgström, MSc, Stockholm Health Economics, Stockholm, and colleagues used a Markov model to evaluate the cost-effectiveness of alendronate in men with osteoporosis. Based on the assumption that the benefit of alendronate in reducing fracture risk in women as reported in The Fracture Intervention Trial (FIT) would be the same for men, the authors estimated the cost-effectiveness of alendronate to treat osteoporosis in men from both a societal and health care perspective. The societal perspective considers the direct cost of treatment as well as cost in added life years gained and indirect costs, whereas the health care perspective does not include cost in added life years gained or indirect costs. Quality adjusted life years (QALY) gained and life years gained were used as outcome measures. A 10-year reduced fracture risk effect with alendronate was assumed -- 5 years of treatment followed by 5 years in which this benefit declined linearly to zero. Patients were followed from start of treatment to age 100 or death.

To determine cost-effectiveness, a threshold cost of 60 000 euros (ie, the willingness to pay for costs that do not exceed this amount) in terms of cost to society and 30 000 euros in terms of cost in terms of health care perspective were used based on previously published economic analyses.

From a societal perspective, the cost per QALY gained was 14 843 euros and 33 363 euros for the cost of life year gained. From a health care perspective, the cost per QALY gained was 5314 euros and 11 945 euros for the cost per life year gained. Using the threshold of 60 000 euros as determining cost-effectiveness, the study found a 97% chance that alendronate was cost effective in societal terms and 92% chance in terms of a health care perspective (ie, assuming a threshold of 30 000 euros).

The authors conclude that "treatment with alendronate gives a comparatively high health benefit (improvement in quantity and/or quality of life) for the money spent on treatment."

Bone 2004 Jun;34:6:1064-71. "Cost effectiveness of alendronate for the treatment of male osteoporosis in Sweden"

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