Efficacy and cost-effectiveness of alendronate for the prevention of fractures in postmenopausal women in Norway( 25.05.2011 )
This HTA replaces Report 05-2010, ISBN 978-82-8121-331-9, which was withdrawn because of errors in the estimation of treatment effect.
Background: The Norwegian guidelines for prevention and treatment of osteoporosis and osteoporosis-related fractures recommend treatment with bisphosphonates for women with T-score less than -1.6 and previous fractures and also for women with T-score less than or equal to -2.5 without previous fracture. Only women with T-score equal to or less than -2.5 who have previous fractures will have their drug expenses reimbursed.
The guideline was last revised in 2005. Since then, the price of alendronate has been reduced by 80%. The University of Oslo has asked the Norwegian Knowledge Centre for the Health Services to evaluate how this price reduction affects the cost-effectiveness of alendronate.
Methods: We developed a model based economic evaluation with a lifetime perspective. The model follows a hypothetical cohort of women with respect to fractures of the hip, spine and wrist, late effects after fractures and mortality.
During the course of the model costs and health effects are accumulated as a result of the fractures. Half of the women receive treatment with a combination of alendronate, calcium and vitamin D. The other half only receives calcium and vitamin D. The estimated efficacy of alendronate in combination with calcium and vitamin D compared to calcium and vitamin D only was based on a systematic review of the literature.
- Alendronate is likely to be a cost-effective alternative for women aged 65 and 75 years old with a T-score of equal to or less than -2.5 with no previous fracture and for women with a T-score of equal to or less than -2.0 who has suffered a previous fracture.
- The scarcity of efficacy data for women with a T-score above -2.5 without a previous fracture makes the inferences for these groups very uncertain.