Cost Effectiveness of Multi-Therapy Treatment Strategies in the Prevention of Vertebral Fractures in Postmenopausal Women with Osteoporosis

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Abstract
Objective: The aim of this study was to evaluate the cost effectiveness of multitherapy treatment strategies in the prevention of vertebral fractures in postmenopausal women with osteoporosis. Design: A retrospective, incremental cost-effectiveness analysis was conducted from a societal perspective. It compared 9 treatment strategies over 3 years and incorporated the willingness of patients to initiate and continue each therapy. Main outcome measures and results: Four nondominated strategies formed the efficient frontier in the following order: (i) calcium → no therapy; (ii) ovarian hormone therapy (OHT) → calcium → no therapy [166 Canadian dollars ($Can)]; (iii) OHT → etidronate → calcium → no therapy ($Can2331); and (iv) OHT → alendronate → calcium → no therapy ($Can40 965). The figures in parentheses are the incremental costs per vertebral fracture averted to move to that strategy from the previous strategy for patients who had undergone a hysterectomy. Conclusions: We identified 4 efficient multi-therapy strategies for the treatment of vertebral osteoporosis in postmenopausal women, 2 of which were consistent with the practice guidelines of the Osteoporosis Society of Canada. Decisionmakers may select from among these efficient strategies on the basis of incremental cost effectiveness.

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