Postmenopausal Osteoporotic Women at High Risk of Fracture
Postmenopausal osteoporosis (PMO) is characterized by reduced bone mass leading to an increased risk of fracture. The prevalence of PMO increases with age from approximately 6% at age 50 to over 50% above age 80. The incidence of osteoporotic fractures follows a similar pattern, with wrist fractures peaking at approximately age 70, and vertebral and hip fractures at age 85. Fractures are associated with significant reductions in quality of life caused by disability, pain, and deformity, and they constitute an important cause of death among the elderly.
The high prevalence of osteoporosis, coupled with its significant health consequences, makes effective prevention and treatment a leading concern for managed care organizations (MCOs). Current treatment options include bisphosphonates, calcitonins, and selective estrogen receptor modulators (SERMs). In the U.S., bisphos-phonates are the most widely prescribed, with canadian alendronate having the largest market share. It is a more recently introduced bisphosphonate, which has been shown to significantly reduce the incidence of vertebral and nonvertebral fractures.
As intervention options grow in all therapeutic areas, MCOs are increasingly seeking ways to equitably allocate resources to achieve maximum health care benefits for their subscribers. One approach is to examine the cost-effectiveness of available therapies to prioritize spending. In this study, efficacy data drawn from clinical trials were combined with epidemiological, resource use, and quality-of-life data to assess the cost-effectiveness of competing bisphospho-nate therapies within a Markov state-transition model of PMO. Such economic models are widely used for evaluating pharmaceutical interventions when comparative trials are unavailable and their conduct is prohibitively expensive or would result in unacceptable treatment delays. Models integrate the best available data into an analytic framework that allows head-to-head comparisons of alternative therapies in relevant population subgroups. Furthermore, they are particularly useful in assessing the full impact of therapy in chronic diseases for which treatment might have clinical, quality-of-life, or economic impacts that extend beyond the time horizon of the clinical trials.
The purpose of this study was to evaluate the short-term cost-effectiveness and budget impact of risedronate therapy compared with therapy in the treatment of patients with PMO at high risk of fracture based on T-score at or below -2.5 and a previous vertebral fracture.