Authors' objectives:

Osteoporosis is associated with significant disease burden. Effective therapies for osteoporosis are attractive because their acquisition costs may be offset by future savings associated with fracture prevention. There is a need to assess the value in funding these drugs, given their considerable use and cost with an aging Canadian population.

Authors' recommendations: Implications for Decision Making Neither teriparatide nor bisphosphonates have a demonstrated direct impact on the primary prevention of clinically important fractures. None of the bisphosphonates showed reductions in hip, wrist, or other non-vertebral fractures. Alendronate's effect is limited to an observed reduced risk of radiographic vertebral fractures in one RCT. This surrogate outcome has been linked to excess morbidity and mortality. Teriparatide's effect could not be estimated as no primary prevention trials met the criteria for review. Teriparatide and some bisphosphonates have a demonstrated direct impact on the secondary prevention of clinically important fractures. Teriparatide was shown to reduce the risk of non-vertebral fractures. Alendronate and risedronate showed reductions in risks of non-vertebral fractures and of hip fractures (a major source of morbidity and mortality). Alendronate also reduced the risk of wrist fractures. Etidronate's effect is limited to a reduced risk of vertebral fractures. Alendronate or no therapy are optimal. Etidronate, risedronate, and teriparatide were more costly and less effective than alendronate. Switching from etidronate to generic alendronate would cost an additional C$50 per patient every year. Cost effectiveness depends on age. Relative to no drug therapy, alendronate costs an additional C$169,600 per QALY for a 65-year-old woman. In a 90-year-old, alendronate therapy is less costly and more effective than no therapy. Publicly funding teriparatide would require an additional C$115 million in 2006. This assumes 2.5% of current bisphosphonate users would be switched to teriparatide.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.cadth.ca/publication/660

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)