Meadows Eric S, Klein Robert, Rousculp Matthew D, Smolen Lee, Ohsfeldt Robert L, Johnston Joseph A
Eli Lilly and Company, Indianapolis, IN, USA.
BMC Womens Health. 2007 Apr 17;7:6. doi: 10.1186/1472-6874-7-6.
Limited data are available regarding the cost-effectiveness of preventative therapies for postmenopausal women with osteopenia. The objective of the present study was to evaluate the cost-effectiveness of raloxifene, alendronate and conservative care in this population.
We developed a microsimulation model to assess the incremental cost and effectiveness of raloxifene and alendronate relative to conservative care. We assumed a societal perspective and a lifetime time horizon. We examined clinical scenarios involving postmenopausal women from 55 to 75 years of age with bone mineral density T-scores ranging from -1.0 to -2.4. Modeled health events included vertebral and nonvertebral fractures, invasive breast cancer, and venous thromboembolism (VTE). Raloxifene and alendronate were assumed to reduce the incidence of vertebral but not nonvertebral fractures; raloxifene was assumed to decrease the incidence of breast cancer and increase the incidence of VTEs. Cost-effectiveness is reported in $/QALYs gained.
For women 55 to 60 years of age with a T-score of -1.8, raloxifene cost approximately $50,000/QALY gained relative to conservative care. Raloxifene was less cost-effective for women 65 and older. At all ages, alendronate was both more expensive and less effective than raloxifene. In most clinical scenarios, raloxifene conferred a greater benefit (in QALYs) from prevention of invasive breast cancer than from fracture prevention. Results were most sensitive to the population's underlying risk of fracture and breast cancer, assumed efficacy and costs of treatment, and the discount rate.
For 55 and 60 year old women with osteopenia, treatment with raloxifene compares favorably to interventions accepted as cost-effective.
关于绝经后骨质减少女性预防性治疗的成本效益，现有数据有限。本研究的目的是评估雷洛昔芬、阿仑膦酸钠和保守治疗在该人群中的成本效益。
我们开发了一个微观模拟模型，以评估雷洛昔芬和阿仑膦酸钠相对于保守治疗的增量成本和效果。我们采用社会视角和终身时间范围。我们研究了涉及55至75岁绝经后女性的临床情况，其骨密度T值范围为-1.0至-2.4。模拟的健康事件包括椎体和非椎体骨折、浸润性乳腺癌和静脉血栓栓塞（VTE）。假设雷洛昔芬和阿仑膦酸钠可降低椎体骨折而非非椎体骨折的发生率；假设雷洛昔芬可降低乳腺癌的发生率并增加VTE的发生率。成本效益以每获得的质量调整生命年（QALY）的美元数报告。
对于T值为-1.8的55至60岁女性，相对于保守治疗，雷洛昔芬每获得一个QALY的成本约为50,000美元。雷洛昔芬对65岁及以上女性的成本效益较低。在所有年龄段，阿仑膦酸钠比雷洛昔芬更昂贵且效果更差。在大多数临床情况下，雷洛昔芬通过预防浸润性乳腺癌获得的益处（以QALY计）大于预防骨折的益处。结果对人群潜在的骨折和乳腺癌风险、假设的治疗效果和成本以及贴现率最为敏感。
对于55至60岁患有骨质减少的女性，雷洛昔芬治疗与被认为具有成本效益的干预措施相比具有优势。
