Cost Effectiveness of the German Screen-and-Treat Strategy for Postmenopausal Osteoporosis

Authors: Mueller, Dirk; Weyler, Eva; Gandjour, Afschin

Source: PharmacoEconomics, Volume 26, Number 6, 2008 , pp. 513-536(24)

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Abstract:

Background: The German osteology umbrella organization, Dachverband Osteologie (DVO), has published a new guideline for the secondary prevention of osteoporotic fractures. According to the guideline, women are screened using dual x-ray absorptiometry (DXA). Those with an absolute 10-year fracture risk ≥30% are treated with bisphosphonates such as alendronate or risedronate for 4 years or with teriparatide for 18 months.

Objective: To determine the cost effectiveness of the screen-and-treat strategy versus no intervention in women of the general population aged 50-90 years in Germany.

Methods: Cost-utility and budget-impact analyses were performed from the perspective of the statutory health insurance (SHI). A Markov model with a 1-year cycle length simulated costs and benefits (QALYs), discounted at 3%, over a lifetime horizon. The number of women correctly diagnosed by pre-tests and DXA as having a 10-year fracture risk of ≥30% was estimated for different age groups (50-60, 60-70, 70-80 and 80-90 years). Incremental cost-effectiveness ratios (ICERs) were calculated; all costs are presented in euro, year 2006 values. Robustness of the results was tested by a probabilistic Monte Carlo simulation.

Results: Alendronate was the most cost-effective drug in all age groups; the ICERs were euro3849, euro16 589, euro6600 and euro2337 per QALY for 50-, 60-, 70- and 80-year-old women, respectively, followed by risedronate. Teriparatide was dominated in every age group. Implementing the screen-and-treat strategy would result in annual costs of euro175 million for alendronate (euro181 million for risedronate) or 0.14% of the SHI annual budget. Results were robust in the sensitivity analysis.

Conclusion: While the screen-and-treat strategy would result in a substantial cost increase for the SHI, the use of alendronate within such a strategy appears cost effective when compared with many generally accepted medical interventions.

Keywords: Alendronic acid; Bone mineral density; Cost utility; Osteoporosis; Risedronic acid; Screening; Teriparatide

Document Type: Research article

Affiliations: 1: Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany

Publication date: 2008-01-01

Cost Effectiveness of the German Screen-and-Treat Strategy for Postmenopausal Osteoporosis

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