Cost Effectiveness of Multi-Therapy Treatment Strategies in the Prevention of Vertebral Fractures in Postmenopausal Women with Osteoporosis
Andrew J. Rosner
Daniel T. Grima
George W. Torrance
Jonathan D. Adachi
Rolf J. Sebaldt
Donald J. Willison
Objective: The aim of this study was to evaluate the cost effectiveness of multi-therapy treatment strategies in the prevention of vertebral fractures in postmenopausal women with osteoporosis. Design: A retrospective, incremental cost-effectiveness analysis was conducted from a societal perspective. It compared 9 treatment strategies over 3 years and incorporated the willingness of patients to initiate and continue each therapy. Main outcome measures and results: Four nondominated strategies formed the efficient frontier in the following order: 1. calcium -> no therapy; 2. ovarian hormone therapy (OHT) -> calcium -> no therapy [166 Canadian dollars ($Can)]; 3. OHT -> etidronate -> calcium -> no therapy ($Can2331); and 4. OHT -> alendronate -> calcium -> no therapy ($Can40 965). The figures in parentheses are the incremental costs per vertebral fracture averted to move to that strategy from the previous strategy for patients who had undergone a hysterectomy. Conclusions: We identified 4 efficient multi-therapy strategies for the treatment of vertebral osteoporosis in postmenopausal women, 2 of which were consistent with the practice guidelines of the Osteoporosis Society of Canada. Decision-makers may select from among these efficient strategies on the basis of incremental cost effectiveness.
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