Cost effectiveness of multi-therapy treatment strategies in the prevention of vertebral fractures in postmenopausal women with osteoporosis

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.