Goeree Ron, Blackhouse Gord, Adachi Jonathan
Program for Assessment of Technology in Health (PATH), McMaster University, Ontario, Canada.
Curr Med Res Opin. 2006 Jul;22(7):1425-36. doi: 10.1185/030079906X115568.
During the years following menopause, estrogen levels decline leading to accelerated bone loss and an increased risk of osteoporosis and osteoporosis-related fractures.
Using a Markov model and decision analytic techniques, the long-term costs and outcomes of five treatment and secondary prevention strategies for osteoporosis were compared: 'no intervention', alendronate, etidronate, risedronate, and raloxifene. The base case analysis examined postmenopausal (65 year old) osteoporotic women without prior fracture. Probabilistic sensitivity analysis (PSA) was used to incorporate the impact of parameter uncertainty, and deterministic sensitivity analysis (DSA) was used to compare alternative patient populations and modeling assumptions. Life years and Quality Adjusted Life Years (QALYs) were used as measures of effectiveness.
In the base case analysis, risedronate was dominated by etidronate and alendronate. Alendronate and etidronate were projected to have similar costs and QALYs, and the efficiency frontier was represented by 'no intervention', etidronate, alendronate, and raloxifene (Can$32 571, Can$38 623 and Can$114 070 per QALY respectively). Alternative assumptions of raloxifene's impact on CHD and breast cancer, alternative discount rates and alternative patient risk factors (e.g., starting age of therapy, CHD risk, and prior fracture risk) had significant impacts on the overall cost-effectiveness results for both the bisphosphonates and raloxifene.
Using conventionally quoted benchmarks and compared to no therapy, alendronate, etidronate, and raloxifene would all be considered cost-effective alternatives for treating women with osteoporosis. Potential limitations of this study include the usual caveats and cautions associated with long-term projection models and the fact that not all inputs into the model are Canadian data sources.
在绝经后的数年中，雌激素水平下降，导致骨质流失加速，患骨质疏松症及与骨质疏松症相关骨折的风险增加。
采用马尔可夫模型和决策分析技术，比较了骨质疏松症的五种治疗及二级预防策略的长期成本和结果：“不干预”、阿仑膦酸盐、依替膦酸盐、利塞膦酸盐和雷洛昔芬。基础案例分析研究了无既往骨折史的绝经后（65岁）骨质疏松女性。概率敏感性分析（PSA）用于纳入参数不确定性的影响，确定性敏感性分析（DSA）用于比较不同的患者群体和建模假设。生命年和质量调整生命年（QALY）用作有效性指标。
在基础案例分析中，利塞膦酸盐被依替膦酸盐和阿仑膦酸盐所主导。预计阿仑膦酸盐和依替膦酸盐的成本和QALY相似，效率前沿由“不干预”、依替膦酸盐、阿仑膦酸盐和雷洛昔芬代表（每QALY分别为32571加元、38623加元和114070加元）。雷洛昔芬对冠心病和乳腺癌影响的替代假设、替代贴现率以及替代患者风险因素（例如治疗起始年龄、冠心病风险和既往骨折风险）对双膦酸盐和雷洛昔芬的总体成本效益结果均有显著影响。
使用传统引用的基准并与不治疗相比，阿仑膦酸盐、依替膦酸盐和雷洛昔芬都将被视为治疗骨质疏松症女性的具有成本效益的替代方案。本研究的潜在局限性包括与长期预测模型相关的常见注意事项，以及并非模型中的所有输入均来自加拿大数据源这一事实。
