Abstract

Summary

We performed a cost-effectiveness analysis comparing 5 versus 10 years of alendronate treatment prior to 5-year drug holiday for US postmenopausal women with hip BMD T-scores between − 2.5 and − 3.5. We found that for most postmenopausal women 5 years of treatment prior to drug holiday is the more effective and cost-effective option.

Introduction

We performed a cost-effectiveness analysis to compare 5 versus 10 years of alendronate treatment prior to 5-year drug holiday for postmenopausal osteoporotic women.

Methods

We created an individual-level state-transition microsimulation model to compare 3 treatment strategies for US postmenopausal women with osteoporosis and femoral neck BMD T-scores between − 2.5 and − 3.5 at baseline: recurrent periods of 5 years of alendronate followed by 5 years of drug holiday (alendronate 5/5), recurrent periods of 10 years of alendronate followed by 5 years of drug holiday (alendronate 10/5), and no alendronate treatment.

Results

Base-case analysis revealed for women initiating treatment at ages 50, 60, and 70, the alendronate 5/5 strategy dominated (was more effective and less costly than) the alendronate 10/5 strategy and no treatment. For women age 80, the alendronate 10/5 strategy dominated. When assuming a lower relative risk of nonvertebral fracture during years 6–10 of alendronate treatment than the base-case assumption, the alendronate 10/5 strategy became the most cost-effective strategy even at younger treatment initiation ages. Probabilistic sensitivity analysis results supported the base-case findings; for treatment initiation ages of 50, 60, and 70, the alendronate 5/5 strategy was favored, whereas for treatment initiation age of 80, the alendronate 10/5 strategy was favored; however, there was uncertainty in these findings.

Conclusions

After 5 years of alendronate treatment, younger postmenopausal women (ages 50–70) with osteoporosis would likely benefit from a drug holiday, whereas older women (age 80) are likely to benefit from treatment for 10 years before a drug holiday.

中文翻译：

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骨质疏松症妇女在放假前进行阿仑膦酸盐治疗5年或10年的成本效益

摘要

概要

我们进行了一项成本效益分析，比较了5月休假前5年和10年的阿仑膦酸盐治疗对美国BMD T值在-2.5至-3.5之间的绝经后妇女的影响。我们发现，对于大多数绝经后妇女而言，在放假前进行5年的治疗是更有效和更具成本效益的选择。

介绍

我们进行了一项成本效益分析，比较了绝经后骨质疏松症妇女在5年药物休假前5年和10年的阿仑膦酸盐治疗的情况。

方法

我们创建了个人水平的状态转换微观模拟模型，以比较基线时− 2.5至− 3.5的美国绝经后骨质疏松和股骨颈BMD T评分的3种治疗策略：阿仑膦酸5年的复发期和5年阿仑膦酸盐的复发期禁药期（阿仑膦酸盐5/5），阿仑膦酸盐的10年复发期，随后的5年的药物假期（阿仑膦酸盐10/5）和无阿仑膦酸盐治疗。

结果

基本案例分析显示，对于在50、60和70岁开始接受治疗的女性，阿仑膦酸5/5策略占主导地位（比阿仑膦酸盐10/5策略更有效且成本更低），且无治疗。对于80岁的女性，阿仑膦酸盐10/5策略占主导地位。如果假设阿仑膦酸盐治疗6-10年间非椎骨骨折的相对危险性低于基本病例假设，则即使在较年轻的治疗起始年龄，阿仑膦酸盐10/5策略也成为最具成本效益的策略。概率敏感性分析结果支持了基本案例的发现；对于起始治疗年龄分别为50、60和70的患者，推荐使用阿仑膦酸盐5/5策略，而对于起始治疗年龄为80的患者，建议采用阿仑膦酸盐10/5策略；但是，这些发现并不确定。

结论

在经过5年的阿仑膦酸盐治疗后，患有骨质疏松症的年轻绝经后妇女（50-70岁）可能会受益于放假，而年龄较大的妇女（80岁）则可能会受益于放假前10年的治疗。