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Alendronate, zoledronate most cost-effective drugs for osteoporosis
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Generic oral alendronate or generic parenteral zoledronate were the most cost-effective therapies in the United States for women with postmenopausal osteoporosis, according to data from a meta-analysis.
“Osteoporotic fractures are associated with morbidity, pain, disability and death,” Stewart G. Albert, MD, professor of internal medicine, division of endocrinology at St. Louis University School of Medicine, and colleagues wrote. “Standard prevention is considered generic oral bisphosphonates, with parenteral medications reserved for intolerance to the oral medications. The decision to prescribe any of these medications depends on the efficacy and side effects. There is also a responsibility to use these medications in a cost-effective manner.”
Albert and colleagues reviewed data from six recent meta-analyses of randomized controlled trials on anti-osteoporotic drugs using the PubMed and SCOPUS databases. All trials had been conducted between 2013 and March 2016. The researchers evaluated cost comparisons among drugs, assuming first-line therapy was generic alendronate.
From the meta-analyses, Albert and colleagues evaluated 43 trials including 71,809 postmenopausal women. Mean recruitment age was 67.3 years, and mean duration of follow-up was 25.5 months. Both denosumab and teriparatide showed improved reduction in vertebral fractures compared with alendronate, with an incremental cost of $46,000 per fracture prevented for denosumab and $455,000 per fracture prevented for teriparatide, the researchers reported.
Albert and colleagues wrote that switching from alendronate to another drug offered no statistical benefit in preventing hip fractures, and that switching alendronate to teriparatide for prevention of non-vertebral fractures would cost an additional $1,556,000.
The researchers acknowledged several limitations to their study: Different studies used a variety of enrollment parameters for patients and used different parameters to evaluate outcomes. Albert and colleagues also noted that they did not “have any information that would suggest an age-dependent differential benefit of one medicine over another” because studies all evaluated postmenopausal women of similar ages.
“In conclusion, a clinical algorithm would start with oral generic alendronate unless clinically contraindicated, and alternative therapy would be considered on the basis of side effect or toxicity,” the researchers wrote. “An argument could be made for the use of zoledronate as an alternative first-line parenteral medication or used after recurrent fractures if medication adherence was a consideration, and denosumab used if there were further restrictions on bisphosphonate use.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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