Cost-effectiveness of dual energy X-ray absorptiometry (DXA) plus anti-resorptive treatment in Australian women with breast cancer who receive aromatase inhibitors

We examined the cost-effectiveness of dual energy X-ray absorptiometry (DXA) with anti-resorptive (AR) therapy compared with fracture risk assessment, lifestyle advice, and vitamin supplementation. We used a hypothetical Markov cohort model of lifetime duration for 60-year-old women with early stage breast cancer receiving AIs. The data to populate the model came from the published medical literature, epidemiological reports, and national costing datasets. Two eligibility scenarios for AR therapy were considered: (A) osteoporosis, and (B) osteopenia or osteoporosis. The main outcomes were incremental cost per quality-adjusted life years gained and cumulative fractures per 1000 women, calculated relative to the comparator of lifestyle advice and dietary supplements. Due to a low number of accumulated fractures, the outcomes were primarily driven by costs. The incremental cost per quality-adjusted life years gained was A$4155 and A$20,075 for scenarios A and B, respectively. The numbers of fractures avoided were 12 and 32 per 1000 women, respectively. The results were somewhat sensitive to discount rates, the cost of AR therapy, and the initial probability of osteoporosis. Compared with risk assessment and lifestyle advice only, a DXA scan followed by an AR treatment is potentially cost-effective for women aged 60 and over undergoing AI therapy for early breast cancer. However, the number of fractures averted through this intervention is small.
Source: Journal of Bone and Mineral Metabolism - Category: Orthopaedics Source Type: research