Tuesday, May 18, 2010 (Last Updated: 05/20/2010)
TUESDAY, May 18 (HealthDay News) -- A bone mineral density test followed by selective use of alendronate for fracture prevention in men beginning androgen deprivation therapy for localized prostate cancer is cost-effective, according to research published in the May 18 issue of the Annals of Internal Medicine.
Kouta Ito, M.D., of Memorial Sloan-Kettering Cancer Center in New York City, and colleagues used modeling techniques to assess the cost-effectiveness of three alternative strategies for preventing fractures in a hypothetical cohort of men aged 70 years starting a two-year course of androgen deprivation therapy (ADT) for locally advanced or high-risk localized prostate cancer: bone mineral density (BMD) testing for all, with alendronate therapy for those men with osteoporosis; no screening and no alendronate treatment of any man; and universal alendronate treatment for all men undergoing ADT with a BMD test. The measured outcome was the incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life-year (QALY) gained.
For the strategy of using BMD testing followed by selective use of alendronate, the ICER was $66,800 per QALY gained. For the alternate strategy of universal alendronate therapy, the ICER was $178,700 per QALY gained. Factors that might lower the ICER and make universal alendronate more cost-effective were an assumption of older age, previous fracture history, lower pre-ADT BMD, and a lower cost of alendronate.
"These results are encouraging and suggest that prevention of bone loss with alendronate is cost-effective when treatment is targeted to patients at high risk for fractures. Our results also suggest that Medicare coverage of a BMD test could be expanded to this patient population. Future research should assess whether the effect of alendronate on BMD correlates with a reduction in fracture rates in this patient population," the authors write.
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