>Cost-Effectiveness of Hormone Therapy Versus Calcium Therapy: An Osteoporosis Markov Model

Authors: Keys P.¹; Touchette D.²

Source: Value in Health, Volume 1, Number 1, May 1998 , pp. 65-66(2)

Publisher: Wiley-Blackwell

Abstract:

Osteoporosis is a chronic degenerative disease with concentrated prevalence in the most rapidly growing segment of the population, the elderly. Its clinical and economic consequences are substantial. This study assesses the cost-effectiveness of two gold standard therapeutic approaches to reducing the impact of related fractures.

OBJECTIVES: To determine the cost-effectiveness ratios of the two therapeutic approaches. To model the cohort progression through the Markov states.

METHODS: Using published literature values, a Markov model was constructed. The model depicts a cohort of 1,000 women progressing from age 50 to 90 years or death, whichever comes first. The hormone therapy alternative includes calcium supplementation as part of the regimen. The model accounts for the following confounders: age dependent rate of death, predisposition to subsequent fracture, and the cardioprotective effect of hormone therapy. Sensitivity analysis was conducted on all relevant variables to assess the robustness of the findings. The primary outcome of interest was cost per fracture avoided. Additionally, Markov analysis of the model reports the distribution of women across each Markov state.

RESULTS: The study revealed that hormone therapy is more cost-effective than calcium therapy. Cost-effectiveness ratios for the two alternatives were $43,729.82 and $87,003.53 per fracture avoided for hormone therapy and calcium therapy, respectively. The incremental cost-effectiveness ratio was $32,828.60, indicating the cost of avoiding each additional fracture using the less desirable calcium therapy. The cardioprotective effect of hormone therapy accounted for nearly 3 additional years of life for each woman on therapy.

CONCLUSIONS: Hormone replacement therapy in conjunction with calcium supplementation is far more cost-effective than calcium supplementation alone.

Document Type: Research article

DOI: http://dx.doi.org/10.1046/j.1524-4733.1998.1100628.x

Affiliations: 1: Wayne State University College of Pharmacy and Allied Health Professions, Detroit, MI, USA 2: Detroit Medical Center Receiving Hospital, Detroit, MI, USA

Publication date: 1998-05-01

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