Which Osteoporosis Treatments Are Most Cost-Effective?

Generic oral alendronate and generic parenteral zolendronate are the most cost-effective osteoporosis treatments for postmenopausal women, according to a recent meta-analysis.

To compare fracture frequency among postmenopausal women, the researchers assessed existing meta-analyses using SCOPUS and PubMed between 2013, which overlapped the latest meta-analyses, and March 2016. Primary references used in the analysis included all randomized controlled trials comparing anti-osteoporotic drugs with comparators.
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Overall, the researchers assessed 71,809 postmenopausal women enrolled in 43 trials. The mean age of participants was 67.3 years, and mean follow-up was 25.5 years. The researchers also compared costs of various treatment strategies that assumed generic alendronate as first-line therapy.

Results indicated that generic oral alendronate and generic parenteral zoledronate were the most cost-effective treatments for postmenopausal women with osteoporosis. The researchers found that the treatments denosumab and teriparatide helped reduce vertebral fractures vs alendronate, preventing costs of $46,000 and $455,000 per fracture, respectively. Generic zoledronate would cost either a lesser or similar amount.

None of the alternative medications better prevented hip fractures, the researchers noted. However, teriparatide was more effective in preventing nonvertebral fractures at an incremental cost of $1,555,000.

“The most cost-effective initial therapy of postmenopausal osteoporosis is generic oral alendronate or generic parenteral zoledronate,” the researchers concluded. “There is no statistically significant difference in efficacy of available drugs to prevent hip fractures. There are limited data to suggest switching drugs after sustaining an osteoporotic fracture while on oral alendronate therapy, although generic zoledronate may be considered on the basis of side effects or questions of medication adherence.”

—Christina Vogt

Reference:

Albert SG, Reddy S. Clinical evaluation of cost efficacy of drugs for treatment of osteoporosis: a meta-analysis. Endocr Pract. 2017;23(7). doi:10.4158/EP161678.RA.