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Teriparatide alone is less cost-effective than alendronate alone for the treatment of women with severe osteoporosis

Teriparatide is a promising new agent for the treatment of osteoporosis (loss of bone mass density). The drug increases bone density and reduces fractures in women with severe osteoporosis (those with low bone mass and preexisting fractures) by directly stimulating new bone formation. Yet therapy with teriparatide alone is more expensive and produces a smaller increase in quality-adjusted life years (QALYs) than therapy with alendronate, the U.S. market leader in osteoporosis medications. Sequential teriparatide/alendronate therapy appears expensive; however, it could become more cost-effective in certain circumstances.

Researchers analyzed data from three osteoporosis fracture trials to compare the cost per QALY for usual care (calcium or vitamin D supplementation) with that of three medication strategies for the first-line treatment of high-risk osteoporotic women (postmenopausal white women with low bone density and vertebral fracture). The three medication strategies included 5 years of alendronate therapy, 2 years of teriparatide therapy, and 2 years of teriparatide therapy followed by 5 years of alendronate therapy (sequential teriparatide/alendronate).

Compared with usual care, the cost of alendronate treatment was $11,600 per QALY. Teriparatide alone was less cost-effective than alendronate at $172,300 per QALY, even if its efficacy lasted 15 years after treatment. The cost of sequential teriparatide/alendronate therapy was $156,500 per QALY compared with alendronate alone. This sequential therapy was less cost-effective than alendronate, even if fractures were eliminated during the alendronate phase. However, it would become cost-effective (less than $50,000 per QALY) if the price of teriparatide decreased 60 percent, if used in elderly women with severe osteoporosis, or if 6 months of teriparatide therapy had comparable efficacy to 2 years of treatment. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00028).

See "The cost-effectiveness of therapy with teriparatide and alendronate in women with severe osteoporosis," by Hau Liu, M.D., M.B.A., M.P.H., Kaleb Michaud, M.S., Smita Nayak, M.D., and others, in the June 12, 2006, Archives of Internal Medicine 166, pp. 1209-1217.

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