Abstract
Background: Norwegian guidelines recommend treatment with bisphosphonates for women
considered at high risk of osteoporosis. Alendronate is the most used bisphosphonate.
Recently the price of alendronate has fallen by 75% due to the expiring of the patent. This
may influence the cost effectiveness of the drug.
Objective: To estimate the incremental costs and effects of treating postmenopausal,
osteopenic women with alendronate in addition to calcium and vitamin D instead of calcium
and vitamin D alone.
Design: Markov model with seven health states: well, well after fracture, mild hip fracture
sequela, moderate hip fracture sequela, severe hip fracture sequela, vertebral sequela and
dead. The model encompasses three events: hip, vertebral and forearm fracture.
Data sources: Literature searches in the databases Medline, EMBASE and Cochrane to
identify data on fracture incidence, efficacy, of alendronate and quality of life. Costs are
estimated using Norwegian fee schedules for 2006. Mortality rates for 2006 from Statistics
Norway.
Target population: Postmenopausal women, aged 65-75 with femoral neck T-score between
-1.5 and -2.5 living in Oslo.
Time horizon: Until death or age of 100.
Perspective: Broad health care
Interventions: Four years of treatment with alendronate. Offset time three years.
Outcome measures: The results are expressed as incremental costs, incremental quality
adjusted life years, and costs per QALY gained.
Results: Treatment with alendronate was cost saving and more effective for all groups.
Results of sensitivity analysis: The results of the one-way sensitivity analyses indicate that
this conclusion is robust to any realistic change of the model input.
Limitations: Results apply mainly to postmenopausal, Caucasian women in Oslo.
Conclusions: The results indicate that treatment with alendronate, at the current price level, is
cost saving and more effective compared to no treatment for a wide group of women