Cost-effectiveness of alendronate in the treatment of postmenopausal women in 9 European countries : an economic evaluation based on the fracture intervention trial

• Published in: Osteoporosis international Vol. 18; no. 8; pp. 1047 - 1061
• Main Authors: STRÖM, O, BORGSTRÖM, F, SEN, S. S, BOONEN, S, HAENTJENS, P, JOHNELL, O, KANIS, J. A
• Format: Journal Article
• Language: English
• Published: London Springer 01.08.2007; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; alendronate; Alendronate - economics; Alendronate - therapeutic use; Biological and medical sciences; bisphosphonates; Bone Density Conservation Agents - economics; Bone Density Conservation Agents - therapeutic use; Bones, joints and connective tissue. Antiinflammatory agents; Clinical Medicine; Computer Simulation; cost; Cost analysis; Cost-Benefit Analysis; Diseases of the osteoarticular system; Drug therapy; Europe; Europe - epidemiology; Female; fracture; Fractures; Fractures, Spontaneous - economics; Fractures, Spontaneous - epidemiology; Fractures, Spontaneous - prevention & control; Health economics; Humans; Injuries of the limb. Injuries of the spine; Klinisk medicin; Markov Chains; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Older people; Orthopedics; Ortopedi; Osteoporosis; Osteoporosis, Postmenopausal - drug therapy; Osteoporosis, Postmenopausal - economics; Osteoporosis, Postmenopausal - epidemiology; Osteoporosis. Osteomalacia. Paget disease; Pharmacology. Drug treatments; Quality of Life; Quality-Adjusted Life Years; Risk reduction; Spinal Fractures - economics; Spinal Fractures - epidemiology; Spinal Fractures - prevention & control; Spine; Traumas. Diseases due to physical agents; Women; Europe; Human; Costs; Diseases of the osteoarticular system; Alendronate, Bisphosphonates; Diphosphonic acid derivatives; Fracture; Trauma; Bisphosphonates; Cost; Europe Fracture, Osteoporosis; Alendronic acid; Osteoporosis; Treatment; Health economy; Postmenopause; Woman; Public health
• ISSN: 0937-941X; 1433-2965; 1433-2965
• DOI: 10.1007/s00198-007-0349-5

Treatment with alendronate (Fosamax) has been shown to significantly reduce the risk of fragility fractures. Cost-effectiveness of treatment was assessed in nine European countries in a Markov model and was generally found to be cost effective in women with a previous spine fracture. Treatment with alendronate (Fosamax) reduces the risk of osteoporotic fractures at the spine, hip and wrist in women with and without prevalent vertebral fracture. Cost-effectiveness estimates in one country may not be applicable elsewhere due to differences in fracture risks, costs and drug prices. The aim of this study was to assess the cost-effectiveness of treating postmenopausal women with alendronate in nine European countries, comprising Belgium, Denmark, France, Germany, Italy, Norway, Spain, Sweden, and the UK. A Markov model was populated with data for the nine European populations. Effect of treatment was taken from the Fracture Intervention Trial, which recruited women with low BMD alone or with a prior vertebral fracture. The cost per QALY gained of treating postmenopausal women with prior vertebral fractures ranged in the base case from "cost saving" in the Scandinavian countries to 15,000 in Italy. Corresponding estimates for women without prior vertebral fractures ranged from "cost saving" to 40,000. In relation to thresholds generally used, the analysis suggests that alendronate is very cost effective in the treatment of women with previous vertebral fracture, and in women without previous vertebral fracture, cost-effectiveness depends on the country setting, discount rates, and chosen monetary thresholds.