Universal bone densitometry screening combined with alendronate therapy for those diagnosed with osteoporosis is highly cost-effective for elderly women

John T. Schousboe, Kristine E. Ensrud, John A. Nyman, L. Joseph Melton, Robert L. Kane

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

OBJECTIVES: To investigate the cost-effectiveness of universal bone densitometry in women aged 65 and older combined with alendronate treatment for those diagnosed with osteoporosis (femoral neck T-score ≤ -2.5). DESIGN: A Markov model with a lifetime time horizon and eight health states (no fracture, distal forearm fracture, radiographic (but clinically inapparent) vertebral fracture, clinical vertebral fracture, hip fracture, hip and vertebral fracture, and other fractures), using the societal perspective. SETTING: Women living independently and those in nursing homes. PARTICIPANTS: Caucasian women aged 65, 75, 85, or 95. INTERVENTION: Bone densitometry of the hip, with 5 years of alendronate therapy for those found to have osteoporosis versus no intervention (densitometry or drug therapy). MEASUREMENTS: Lifetime accumulated quality adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios. RESULTS: The cost per QALY gained for the screen-and-treat strategy was $43,000 per QALY gained for 65-year-old women and $5,600 per QALY gained for 75-year-old women. For 85- and 95-year-old women, the screen-and-treat strategy was cost saving. Sensitivity analyses showed that the screen-and-treat strategy was cost-effective even under assumptions of reduced adherence to drug therapy, reduced fracture reduction benefit from alendronate therapy, or reduced QALYs saved by preventing fracture. CONCLUSION: Universal bone densitometry combined with alendronate therapy for those found to have osteoporosis is highly cost-effective for women aged 65 and older and may be cost saving for ambulatory women aged 85 and older (whether independently living or residing in nursing homes).

Original languageEnglish (US)
Pages (from-to)1697-1704
Number of pages8
JournalJournal of the American Geriatrics Society
Volume53
Issue number10
DOIs
StatePublished - Oct 2005

Fingerprint

Alendronate
Densitometry
Osteoporosis
Quality-Adjusted Life Years
Costs and Cost Analysis
Bone and Bones
Hip Fractures
Therapeutics
Nursing Homes
Cost-Benefit Analysis
Pelvic Bones
Drug Therapy
Fracture Fixation
Femur Neck
Forearm
Health

Keywords

  • Alendronate
  • Bone densitometry
  • Cost-effectiveness
  • Osteoporosis

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Universal bone densitometry screening combined with alendronate therapy for those diagnosed with osteoporosis is highly cost-effective for elderly women. / Schousboe, John T.; Ensrud, Kristine E.; Nyman, John A.; Melton, L. Joseph; Kane, Robert L.

In: Journal of the American Geriatrics Society, Vol. 53, No. 10, 10.2005, p. 1697-1704.

Research output: Contribution to journalArticle

Schousboe, John T. ; Ensrud, Kristine E. ; Nyman, John A. ; Melton, L. Joseph ; Kane, Robert L. / Universal bone densitometry screening combined with alendronate therapy for those diagnosed with osteoporosis is highly cost-effective for elderly women. In: Journal of the American Geriatrics Society. 2005 ; Vol. 53, No. 10. pp. 1697-1704.
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AU - Ensrud, Kristine E.

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AU - Melton, L. Joseph

AU - Kane, Robert L.

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N2 - OBJECTIVES: To investigate the cost-effectiveness of universal bone densitometry in women aged 65 and older combined with alendronate treatment for those diagnosed with osteoporosis (femoral neck T-score ≤ -2.5). DESIGN: A Markov model with a lifetime time horizon and eight health states (no fracture, distal forearm fracture, radiographic (but clinically inapparent) vertebral fracture, clinical vertebral fracture, hip fracture, hip and vertebral fracture, and other fractures), using the societal perspective. SETTING: Women living independently and those in nursing homes. PARTICIPANTS: Caucasian women aged 65, 75, 85, or 95. INTERVENTION: Bone densitometry of the hip, with 5 years of alendronate therapy for those found to have osteoporosis versus no intervention (densitometry or drug therapy). MEASUREMENTS: Lifetime accumulated quality adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios. RESULTS: The cost per QALY gained for the screen-and-treat strategy was $43,000 per QALY gained for 65-year-old women and $5,600 per QALY gained for 75-year-old women. For 85- and 95-year-old women, the screen-and-treat strategy was cost saving. Sensitivity analyses showed that the screen-and-treat strategy was cost-effective even under assumptions of reduced adherence to drug therapy, reduced fracture reduction benefit from alendronate therapy, or reduced QALYs saved by preventing fracture. CONCLUSION: Universal bone densitometry combined with alendronate therapy for those found to have osteoporosis is highly cost-effective for women aged 65 and older and may be cost saving for ambulatory women aged 85 and older (whether independently living or residing in nursing homes).

AB - OBJECTIVES: To investigate the cost-effectiveness of universal bone densitometry in women aged 65 and older combined with alendronate treatment for those diagnosed with osteoporosis (femoral neck T-score ≤ -2.5). DESIGN: A Markov model with a lifetime time horizon and eight health states (no fracture, distal forearm fracture, radiographic (but clinically inapparent) vertebral fracture, clinical vertebral fracture, hip fracture, hip and vertebral fracture, and other fractures), using the societal perspective. SETTING: Women living independently and those in nursing homes. PARTICIPANTS: Caucasian women aged 65, 75, 85, or 95. INTERVENTION: Bone densitometry of the hip, with 5 years of alendronate therapy for those found to have osteoporosis versus no intervention (densitometry or drug therapy). MEASUREMENTS: Lifetime accumulated quality adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios. RESULTS: The cost per QALY gained for the screen-and-treat strategy was $43,000 per QALY gained for 65-year-old women and $5,600 per QALY gained for 75-year-old women. For 85- and 95-year-old women, the screen-and-treat strategy was cost saving. Sensitivity analyses showed that the screen-and-treat strategy was cost-effective even under assumptions of reduced adherence to drug therapy, reduced fracture reduction benefit from alendronate therapy, or reduced QALYs saved by preventing fracture. CONCLUSION: Universal bone densitometry combined with alendronate therapy for those found to have osteoporosis is highly cost-effective for women aged 65 and older and may be cost saving for ambulatory women aged 85 and older (whether independently living or residing in nursing homes).

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KW - Osteoporosis

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