John T. Schousboe, MD, MS; John A. Nyman, PhD; Robert L. Kane, MD; Kristine E. Ensrud, MD, MPH
Potential Financial Conflicts of Interest: Grants received: J.T. Schousboe (Hologic, Inc.), K.E. Ensrud (Eli Lilly & Co., Pfizer, NPB Pharmaceuticals).
Requests for Single Reprints: John T. Schousboe, MD, MS, Park Nicollet Clinic, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416; e-mail, email@example.com.
Current Author Addresses: Dr. Schousboe: Park Nicollet Clinic, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416.
Drs. Nyman and Kane: Division of Health Services Research and Policy, School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455.
Dr. Ensrud: Department of Medicine, Minneapolis Veterans Administration Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.
Author Contributions: Conception and design: J.T. Schousboe, R.L. Kane.
Analysis and interpretation of the data: J.T. Schousboe, J.A. Nyman, K.E. Ensrud.
Drafting of the article: J.T. Schousboe.
Critical revision of the article for important intellectual content: J.T. Schousboe, R.L. Kane, K.E. Ensrud.
Final approval of the article: J.T. Schousboe, R.L. Kane, K.E. Ensrud.
Administrative, technical, or logistic support: J.T. Schousboe, R.L. Kane.
Collection and assembly of data: J.T. Schousboe.
Schousboe J., Nyman J., Kane R., Ensrud K.; Cost-Effectiveness of Alendronate Therapy for Osteopenic Postmenopausal Women. Ann Intern Med. 2005;142:734-741. doi: 10.7326/0003-4819-142-9-200505030-00008
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Published: Ann Intern Med. 2005;142(9):734-741.
Many postmenopausal women have osteopenia but not osteoporosis or fracture history. Information about the cost-effectiveness of treating such women with alendronate should guide clinical recommendations.
The investigators estimate that the costs of treating postmenopausal women with osteopenia (femoral neck T-scores > −2.5) for 5 years with alendronate range from $70 000 to $332 000 per quality-adjusted life-year.
Unless the cost of alendronate decreases or new data show that alendronate reduces fracture risk more than is currently thought, treatment of osteopenia with alendronate costs more than Americans are typically willing to pay for health care interventions.
Lonnie B. Hanauer
May 6, 2005
Alendronate therapy and cost
To the Editor:
I agree that "osteopenia" is a "non-disease" (according to the British Mediacl J.) and that treatment as desired by the pharmaceutical industry and those owning bone density machines is seldom if ever justified, especially when cost-effectiveness is given consideration.
Nevertheless, I note that the article by Schousboe, et.al. lists the annual cost of alendronate in 2001 as $842 or about $16 per week, which I assume is for one 35 mg tablet weekly, the dose that Merck advises for treatment of osteopenia. In 2005, my local pharmacy advises that one 70 mg tablet of alendronate costs $23.39. One 35 mg tablet costs $24.39 (they sell fewer of this strength) and one 10 mg tablet, $3.48.
Any physician who feels compelled, despite the evidence, to treat "osteopenia" with a 35 mg dose should at least consider telling the patient to cut a 70 mg tablet in half or take three or four 10 mg tablets weekly at a cost of $11-14 tablets. Just because pharmaceutical companies believe physicians are too obtuse to be aware of the cost of drugs, we should occasionally try to not let them get away with it. Lonnie B. Hanauer, M.D., F.A.C.P., 116 Millburn Ave, Millburn, NJ 07041
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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