Cost effectiveness of fracture prevention in postmenopausal women who receive aromatase inhibitors for early breast cancer Journal Article


Authors: Ito, K.; Blinder, V. S.; Elkin, E. B.
Article Title: Cost effectiveness of fracture prevention in postmenopausal women who receive aromatase inhibitors for early breast cancer
Abstract: Purpose: Aromatase inhibitors (AIs) increase the risk of osteoporosis and related fractures in postmenopausal women who receive adjuvant AIs for hormone receptor (HR) -positive early breast cancer (EBC). We compared the cost effectiveness of alternative screening and treatment strategies for fracture prevention.Methods: We developed a Markov state transition model to simulate clinical practice and outcomes in a hypothetical cohort of women age 60 years with HR-positive EBC starting a 5-year course of AI therapy after primary surgery for breast cancer. Outcomes were quality-adjusted life-years (QALYs), lifetime cost, and incremental cost-effectiveness ratio (ICER). We compared the following strategies: no intervention; one-time bone mineral density (BMD) screening and selective bisphosphonate therapy in women with osteoporosis or osteopenia; annual BMD screening and selective bisphosphonate therapy in women with osteoporosis or osteopenia; and universal bisphosphonate therapy.Results: ICERs for annual BMD screening followed by oral bisphosphonates for those with osteoporosis, annual BMD screening followed by oral bisphosphonates for those with osteopenia, and universal treatment with oral bisphosphonates were $87,300, $129,300, and $283,600 per QALY gained, respectively. One-time BMD screening followed by oral bisphosphonates for those with osteoporosis or osteopenia was dominated. Our results were sensitive to age at the initiation of AI therapy, type of bisphosphonates, post-treatment residual effect of bisphosphonates, and a potential adjuvant benefit of intravenous bisphosphonates.Conclusion: In postmenopausal women receiving adjuvant AIs for HR-positive EBC, a policy of baseline and annual BMD screening followed by selective treatment with oral bisphosphonates for those diagnosed with osteoporosis is a cost-effective use of societal resources. © 2012 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 30
Issue: 13
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2012-05-01
Start Page: 1468
End Page: 1475
Language: English
DOI: 10.1200/jco.2011.38.7001
PROVIDER: scopus
PUBMED: 22370313
DOI/URL:
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 1 August 2012" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Elena B Elkin
    149 Elkin
  2. Victoria Susana Blinder
    45 Blinder
  3. Kouta Ito
    6 Ito