Schousboe John T, Nyman John A, Kane Robert L, Ensrud Kristine E
Park Nicollet Health Services, University of Minnesota, and Veterans Administration Medical Center, Minneapolis, Minnesota 55416, USA.
Ann Intern Med. 2005 May 3;142(9):734-41. doi: 10.7326/0003-4819-142-9-200505030-00008.
Treatment guidelines recommend drug treatment to prevent fractures for some postmenopausal women who have low bone mass (osteopenia) but do not have osteoporosis or a history of clinical fractures.
To estimate the societal costs and health benefits of alendronate drug treatment to prevent fractures in postmenopausal women with osteopenia.
Markov model with 8 health states: no fracture, post-distal forearm fracture, post-clinical vertebral fracture, post-radiographic (but clinically inapparent) vertebral fracture, post-hip fracture, post-hip and vertebral fractures, post-other fracture, and death.
Population-based studies of age-specific fracture rates and costs, prospectively measured estimates of disutility after fractures, and the Fracture Intervention Trial of alendronate versus placebo to prevent fracture.
Postmenopausal women 55 to 75 years of age with femoral neck T-scores between -1.5 and -2.4.
Lifetime.
Societal.
Five years of alendronate therapy or no drug treatment.
Costs, quality-adjusted life-years, and incremental cost-effectiveness ratios.
RESULTS OF BASE-CASE ANALYSIS: For women with no additional fracture risk factors, the cost per quality-adjusted life-year gained ranged from 70,000 dollars to 332,000 dollars, depending on age and femoral neck bone density.
Results were sensitive to changes in fracture risk reduction attributable to alendronate and alendronate cost.
Results apply only to postmenopausal white women residing in the United States.
Alendronate therapy for postmenopausal women with femoral neck T-scores better than -2.5 and no history of clinical fractures or other bone mineral density-independent risk factors for fracture is not cost-effective, assuming U.S. costs of alendronate and currently available estimates of alendronate efficacy in osteopenic women.
治疗指南建议对一些骨量低（骨质减少）但未患骨质疏松症或无临床骨折病史的绝经后女性进行药物治疗以预防骨折。
评估阿仑膦酸盐药物治疗预防绝经后骨质减少女性骨折的社会成本和健康效益。
具有8种健康状态的马尔可夫模型：无骨折、桡骨远端骨折后、临床椎体骨折后、影像学（但临床无明显症状）椎体骨折后、髋部骨折后、髋部和椎体骨折后、其他骨折后以及死亡。
基于人群的特定年龄骨折率和成本研究、骨折后失用症的前瞻性测量估计值，以及阿仑膦酸盐与安慰剂预防骨折的骨折干预试验。
55至75岁、股骨颈T值在-1.5至-2.4之间的绝经后女性。
终身。
社会视角。
五年阿仑膦酸盐治疗或不进行药物治疗。
成本、质量调整生命年和增量成本效益比。
对于无其他骨折风险因素的女性，每获得一个质量调整生命年的成本在70,000美元至332,000美元之间，具体取决于年龄和股骨颈骨密度。
结果对阿仑膦酸盐所致骨折风险降低的变化以及阿仑膦酸盐成本敏感。
结果仅适用于居住在美国的绝经后白人女性。
假设阿仑膦酸盐在美国的成本以及目前对其在骨质减少女性中的疗效估计，对于股骨颈T值优于-2.5且无临床骨折病史或其他与骨矿物质密度无关的骨折风险因素的绝经后女性，阿仑膦酸盐治疗不具有成本效益。
