Pfister Alfred K, Welch Christine A, Lester Melissa D, Emmett Mary K, Saville Paul D, Duerring Shea A
Department of Medicine, West Virginia University School of Medicine, Charleston 25304, USA.
South Med J. 2006 Feb;99(2):123-31. doi: 10.1097/01.smj.0000202090.30647.61.
Comparing the cost-effectiveness of various antiosteoporotic drugs has not been defined.
We determined the cost-effectiveness of calcitonin, raloxifene, bisphosphates and PTH in a base-case cohort of women aged 65 or older with osteoporosis. After bone densitometry, women were stratified into groups of treatment or no treatment. Our outcome goal was a value of dollars 100,000 or less per quality-adjusted life years (QALY). A sensitivity analysis varied nonvertebral fracture reduction and compliance between the two most effective strategies to test various cost per QALY thresholds.
Bisphosphonates displayed the most favorable incremental cost saving and prevented more fractures in our base-case analysis. In a sensitivity analysis, virtually all values of bisphosphonates were under dollars 100,000 per QALY and parathyroid hormone (PTH) was between dollars 100,000 and dollars 200,000 per QALY.
Only bisphosphonates are cost-effective for fracture prevention in osteoporotic women aged 65 or older and this economic advantage is also maintained in subsets who have a lower relative risk of future fracture.
各种抗骨质疏松药物的成本效益尚未明确。
我们在一个65岁及以上患有骨质疏松症的女性基础病例队列中确定了降钙素、雷洛昔芬、双膦酸盐和甲状旁腺激素（PTH）的成本效益。在进行骨密度测定后，将女性分为治疗组或非治疗组。我们的结果目标是每质量调整生命年（QALY）100,000美元或更低。敏感性分析在两种最有效的策略之间改变非椎体骨折减少率和依从性，以测试各种每QALY阈值的成本。
在我们的基础病例分析中，双膦酸盐显示出最有利的增量成本节省，并且预防了更多骨折。在敏感性分析中，双膦酸盐的几乎所有值均低于每QALY 100,000美元，而甲状旁腺激素（PTH）为每QALY 100,000美元至200,000美元。
只有双膦酸盐对65岁及以上骨质疏松女性预防骨折具有成本效益，并且这种经济优势在未来骨折相对风险较低的亚组中也得以维持。
