Prevention of osteoporosis: cost-effectiveness of different pharmaceutical treatments

Abstract

The cost-effectiveness of different pharmaceutical programmes to prevent osteoporosis has been compared. The following pharmaceutical treatments were analysed and compared: calcium supplementation, etidronate and calcitonin. As a benchmark for comparison, oestrogen replacement therapy, in the form of both pills and plaster, was also included in the analysis. The cost-effectiveness of different strategies for particular age groups was analysed. Finally, the cost-effectiveness of population-based prevention programmes was compared with the cost-effectiveness of programmes based on screening followed by treatment of women with low bone mineral density (BMD). A cost-effectiveness analysis (CEA) was carried out. The cost/effectiveness ratio computed was net costs per hip fracture avoided. The evaluation was based on a simulation model in which 1000 women were followed from the age of 50 years. The model was based on Danish epidemiological data and Danish health care cost figures. Assumptions concerning the health effect of the pharmaceutical methods of prevention were based on results from existing studies. As different results have been reported, 'optimistic' and 'pessimistic' alternatives were simulated in the model. The analysis revealed large differences in the cost-effectiveness of different pharmaceutical methods; however, the cost-effectiveness is highly sensitive to the treatment effect assumed. Treatment will be more cost-effective the higher the fracture risk of the group treated, so cost-effectiveness will therefore increase the later in life the intervention takes place, and if only women screened for low BMD are treated. However, the overall effect from a general screening programme will be low and highly sensitive to compliance. As compliance with pharmaceutical treatment seems to be low, and as the effectiveness--and thereby the cost-effectiveness--is encumbered with much uncertainty, prevention of osteoporosis through screening for low BMD should not be recommended at present.