Cost-effectiveness of osteoporosis treatments in postmenopausal women using FRAX™ thresholds for decision

Purpose: FRAX (TM) is a fracture prediction algorithm to determine a patient's absolute fracture risk. There is a growing consensus that osteoporosis treatment should be based on individual 10-year fracture probability, as calculated in the FRAX (TM) algorithm, rather than on T-scores alone. Objective: Our objective was to evaluate the cost-effectiveness of five years of branded alendronate therapy in postmenopausal French women with a known FRAX (TM) score. Method: A Markov cohort state transition model using FRAX (TM) values and whenever possible population-specific data and probabilities. We estimated the incremental cost-effectiveness ratio (ICER) of alendronate versus no treatment in postmenopausal women with FRAX (TM) ranging from 10 to 3%. Outcomes: Number of women to treat (NNT) for preventing hip fracture, costs, quality-adjusted life-years, incremental cost-effectiveness ratios. Results: The incremental cost-effectiveness ratios (ICER) compared to no treatment at age 70 ranged from (sic) 104,183 to (sic) 413,473 per QALY when FRAX (TM) decreased from 10 to 3%. The NNTs for preventing one hip fracture ranged from 97 to 388 according to age (50-80 years) and FRAX (TM). Sensitivity analyses showed that the main determinants of cost-effectiveness were adherence to therapy and cost of treatment. Conclusion: Using French costs of branded drug and current estimates of treatment efficacy, alendronate therapy for 70-year-old women with 10-year probability of hip fracture of 10% just meets the accepted cost-effectiveness threshold. Improving treatment adherence and/or decreasing treatment cost lowers the ICER. The model however underestimates the potential benefit by excluding other fractures. (c) 2012 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.