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Osteoporos Int. 2020 Feb 4. doi: 10.1007/s00198-019-05258-2. [Epub ahead of print]

Cost-effectiveness of five versus ten years of alendronate treatment prior to drug holiday for women with osteoporosis.

Author information

1
Berkeley Madonna, Inc., Berkeley, CA, USA. smita.nayak@berkeleymadonna.com.
2
School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

Abstract

We performed a cost-effectiveness analysis comparing 5 versus 10 years of alendronate treatment prior to 5-year drug holiday for US postmenopausal women with hip BMD T-scores between - 2.5 and - 3.5. We found that for most postmenopausal women 5 years of treatment prior to drug holiday is the more effective and cost-effective option.

INTRODUCTION:

We performed a cost-effectiveness analysis to compare 5 versus 10 years of alendronate treatment prior to 5-year drug holiday for postmenopausal osteoporotic women.

METHODS:

We created an individual-level state-transition microsimulation model to compare 3 treatment strategies for US postmenopausal women with osteoporosis and femoral neck BMD T-scores between - 2.5 and - 3.5 at baseline: recurrent periods of 5 years of alendronate followed by 5 years of drug holiday (alendronate 5/5), recurrent periods of 10 years of alendronate followed by 5 years of drug holiday (alendronate 10/5), and no alendronate treatment.

RESULTS:

Base-case analysis revealed for women initiating treatment at ages 50, 60, and 70, the alendronate 5/5 strategy dominated (was more effective and less costly than) the alendronate 10/5 strategy and no treatment. For women age 80, the alendronate 10/5 strategy dominated. When assuming a lower relative risk of nonvertebral fracture during years 6-10 of alendronate treatment than the base-case assumption, the alendronate 10/5 strategy became the most cost-effective strategy even at younger treatment initiation ages. Probabilistic sensitivity analysis results supported the base-case findings; for treatment initiation ages of 50, 60, and 70, the alendronate 5/5 strategy was favored, whereas for treatment initiation age of 80, the alendronate 10/5 strategy was favored; however, there was uncertainty in these findings.

CONCLUSIONS:

After 5 years of alendronate treatment, younger postmenopausal women (ages 50-70) with osteoporosis would likely benefit from a drug holiday, whereas older women (age 80) are likely to benefit from treatment for 10 years before a drug holiday.

KEYWORDS:

Alendronate; Bisphosphonates; Cost-effectiveness analysis; Drug holiday; Osteoporosis

PMID:
32020265
DOI:
10.1007/s00198-019-05258-2

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