Cost-effectiveness of preventative therapies for postmenopausal women with osteopenia

We developed a microsimulation model to assess the incremental cost and effectiveness of raloxifene and alendronate relative to conservative care. We assumed a societal perspective and a lifetime time horizon. We examined clinical scenarios involving postmenopausal women from 55 to 75 years of age with bone mineral density T-scores ranging from -1.0 to -2.4. Modeled health events included vertebral and nonvertebral fractures, invasive breast cancer, and venous thromboembolism (VTE). Raloxifene and alendronate were assumed to reduce the incidence of vertebral but not nonvertebral fractures; raloxifene was assumed to decrease the incidence of breast cancer and increase the incidence of VTEs. Cost-effectiveness is reported in $/QALYs gained.For women 55 to 60 years of age with a T-score of -1.8, raloxifene cost approximately $50,000/QALY gained relative to conservative care. Raloxifene was less cost-effective for women 65 and older. At all ages, alendronate was both more expensive and less effective than raloxifene. In most clinical scenarios, raloxifene conferred a greater benefit (in QALYs) from prevention of invasive breast cancer than from fracture prevention. Results were most sensitive to the population's underlying risk of fracture and breast cancer, assumed efficacy and costs of treatment, and the discount rate.For 55 and 60 year old women with osteopenia, treatment with raloxifene compares favorably to interventions accepted as cost-effective.Osteoporosis has been operationally defined as a bone mineral density (BMD) at least 2.5 standard deviations below that seen in young healthy women (T-score < -2.5) and osteopenia as a BMD T-score between -1 and -2.5[1]. Although the risk of fracture is greater in postmenopausal women with osteoporosis than with osteopenia, there are far more postmenopausal women with BMD values in the normal or osteopenic range[2]. As a result, more fractures occur in women with osteopenia than with osteoporosis [3-6]. Guidelines general