Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women
Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women
复制标题
利塞膦酸盐治疗绝经后妇女骨质疏松症和预防骨折的成本效益
作者：
J. Kanis;F. Borgstrom;O. Johnell;B. Jonsson
随机、双盲、对照研究表明，在绝经后患有椎体骨质疏松症的妇女中，利塞膦酸盐治疗可降低椎体骨折的风险。他们还表明，这种药物降低了患有骨质疏松症的女性发生非脊椎骨折的风险。这项研究的目的是调查利塞膦酸盐治疗绝经后骨质疏松症妇女的成本-效果。马尔科夫模型被应用到英国的环境中。通过随机对照试验的荟萃分析计算治疗效果，并对年龄在60岁至80岁之间的受试者进行为期5年的治疗。以质量调整的寿命年(QALY)和获得的寿命年作为结果指标。在60岁及以上的女性中，利塞膦酸盐的干预是具有成本效益的。对于70岁及以上患有脊椎骨质疏松(既往有脊柱骨折和骨密度T-Score≤−2.5SD)的绝经后女性，也发现了成本节约。对于65岁及以上有脊椎骨折且骨质疏松症临界点骨密度T评分(T-Score=−2.5SD)的女性，以及T-Score≤−2.5SD，但以前没有脊椎骨折的女性，这种治疗是具有成本效益的。在60-80岁和骨质疏松症门槛(T-Score=−2.5SD)但之前没有脊椎骨折的女性中，治疗超过了成本效益门槛。然而，如果假设另一个独立的危险因素(例如，皮质类固醇的使用)，治疗就变得具有成本效益。
Randomized, double-blind, controlled studies have shown that treatment with risedronate reduces the risk of vertebral fracture in postmenopausal women with established vertebral osteoporosis. They also show that the drug decreases the risk of non-vertebral fractures in women with osteoporosis. The aim of this study was to investigate the cost-effectiveness of risedronate in postmenopausal women with osteoporosis. A Markov model was applied to a UK setting. Treatment effects were computed by meta-analysis of randomized, controlled trials and given over 5 years to subjects aged between 60 and 80 years. Quality-adjusted life years (QALYs) and life years gained were used as outcome measures. Intervention with risedronate was cost-effective in women aged 60 years and older. Cost savings were also found for postmenopausal women aged 70 years and older with established vertebral osteoporosis (a prior spine fracture and BMD T-score ≤−2.5 SD). This treatment was cost-effective for women aged 65 years and older who had a prior vertebral fracture and a BMD T-score at the threshold of osteoporosis (T-score=−2.5 SD), and in women with a T-score≤−2.5 SD, but without a prior vertebral fracture. In women aged 60–80 years and at the threshold of osteoporosis (T-score=−2.5 SD) but without a prior vertebral fracture, treatment exceeded the threshold for cost-effectiveness. However, if an additional, independent risk factor was assumed (e.g., corticosteroid use) treatment became cost-effective.