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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1018 — Cost-Effectiveness of Oral Bisphosphonates for Osteoporosis at Different Ages and Levels of Life Expectancy

Datta SK (Durham VA Medical Center), Pham A (Duke University Medical Center), Colon-Emeric C (Durham VA Medical Center)

Objectives:
To evaluate the cost-effectiveness of oral bisphosphonate therapy for osteoporosis in women veterans at different ages and life expectancies.

Methods:
A Markov model with a lifetime horizon was used to conduct the analysis from the VA perspective. The base case involved treatment of osteoporosis (T score = -2.5) with an oral bisphosphonate for 5 years compared to no intervention. Women were divided into health groups according to life expectancy: the ‘sickest’ cohort or the lowest 25th percentile; the median quartiles (25th to 75th percentile); and the ‘healthiest’ quartile or the highest 25th percentile of life expectancy. Monte Carlo simulations were performed for hypothetical cohorts of women initiating treatment at 5-year intervals between ages 50 to 90 years stratified by health group. The model consisted of six health states: osteoporosis without prior fracture, post-hip fracture, post-clincal vertebral fracture, post-other fracture (including forearm, tibia, femur, humerus, and pelvis), post-second hip fracture, and death. Data sources included published fracture rates, utility values, and mortality risks. VA-specific costs were used where available and augmented with Medicare reimbursement rates. Results were generated using 2nd-order Monte Carlo simulation with probabilistic sensitivity analysis.

Results:
For the sickest cohort, oral bisphosphonates had an incremental cost-effectiveness ratio of $4,440/QALY if initiated at age 50 and $2,990/QALY if initiated at age 55; at age 60 and above, osteoporosis treatment was dominant (yielded greater effectiveness at lower cost). For the median and healthiest cohorts, oral bisphosphonate was dominant across all age categories. In sensitivity analysis, although some factors produced estimates that were no longer cost-saving, treatment remained well under a $50,000/QALY threshold across all levels of life expectancy and age of treatment initiation for all model parameters. The treatment also remained cost-effective despite lower medication adherence.

Implications:
Treatment with an oral bisphosphonate for 5 years in women veterans with osteoporosis can be highly cost-effective or cost saving for all ages and for all levels of life expectancy.

Impacts:
Oral bisphosphonates show promise for treating women veterans with osteoporosis. Advanced age and multiple comorbidities should not necessarily prevent consideration of osteoporosis treatment.


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