Cost-utility and Budget Impact Analysis of Primary Prevention With Alendronate of Osteoporotic Hip Fractures in Catalonia

Abstract

ObjectivesTo determine whether primary drug prevention of osteoporotic hip fracture is a useful measure in Catalonia and what would be their budgetary impact. Materials and methodsWe performed a cost-utility social perspective study with a time horizon of 10–20 years. Univariate sensitivity analysis was performed. Doing nothing is compared with an intervention that includes screening for osteoporosis in women >64 years and in those diagnosed and who received treatment with generic alendronate for 10 years. Decision trees are developed for groups of 65–69, 70–74 and 75–79. HF data are from 2009 hospital discharges. Costs are derived from fees paid by public insurance. ResultsIn 2009 there were 9262 HF. The direct cost was € 55 million (€ 5943.4/patient). The total cost was € 227 million for 10 years. The intervention dominates in all age groups in a 20-year perspective. In any horizon and age group, the different scenario puts the value per QALY below or within the proposed values for Spain. The budgetary impact is estimated at € 8.9 million which increased by 31% the actual direct cost, and 0.5% of the public pharmacy budget. Considering the total costs and the prospect of 20 years, annual savings of 7.4 million € were seen. ConclusionsThe prevention of HF with alendronate in osteoporotic women >64 years is cost-useful in the long term (20 years) with a low budgetary impact in the 75–79 year group.