Bisphosphonates, Annual BMD Screen Up Fracture Prevention
(HealthDay News) – In a hypothetical model of postmenopausal women receiving adjuvant aromatase inhibitors (AIs) for hormone receptor (HR)-positive early breast cancer (EBC), baseline and annual bone mineral density (BMD) screening followed by selective treatment with oral bisphosphonates for those diagnosed with osteoporosis is a cost-effective strategy, according to a study published online Feb. 27 in the Journal of Clinical Oncology.
Kouta Ito, MD, of Brigham and Women's Hospital in Boston, and colleagues developed a Markov state transition model to simulate clinical practice and outcomes in a hypothetical cohort of women aged 60 years with HR-positive EBC starting a five-year course of AI therapy following primary surgery for breast cancer. The following strategies were compared: no intervention; one-time 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.
The researchers found that the incremental cost-effectiveness ratio for annual BMD screening followed by oral bisphosphonates for those with osteoporosis was $87,300 per quality-adjusted life-year (QALY) gained; annual BMD screening followed by oral bisphosphonates for those with osteopenia was $129,300 per QALY gained; and universal treatment with oral bisphosphonates was $283,600 per QALY gained. One-time BMD screening followed by oral bisphosphonate therapy for those with osteoporosis or osteopenia was dominated. The 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.
"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," the authors write.