Cost-effectiveness of dual-energy X-ray absorptiometry plus antiresorptive treatment in Australian women with breast cancer who receive aromatase inhibitors

Sowa, P. Marcin, Downes, Martin J. and Gordon, Louisa G. (2017) Cost-effectiveness of dual-energy X-ray absorptiometry plus antiresorptive treatment in Australian women with breast cancer who receive aromatase inhibitors. Journal of Bone and Mineral Metabolism, 35 2: 199-208. doi:10.1007/s00774-016-0742-2


Author Sowa, P. Marcin
Downes, Martin J.
Gordon, Louisa G.
Title Cost-effectiveness of dual-energy X-ray absorptiometry plus antiresorptive treatment in Australian women with breast cancer who receive aromatase inhibitors
Journal name Journal of Bone and Mineral Metabolism   Check publisher's open access policy
ISSN 1435-5604
0914-8779
Publication date 2017-03-01
Year available 2017
Sub-type Article (original research)
DOI 10.1007/s00774-016-0742-2
Open Access Status Not yet assessed
Volume 35
Issue 2
Start page 199
End page 208
Total pages 10
Place of publication Tokyo, Japan
Publisher Springer Japan KK
Language eng
Abstract Postmenopausal women with breast cancer on aromatase inhibitor (AI) treatment are at increased risk of bone mineral density loss, which may lead to minimal trauma fractures. We examined the cost-effectiveness of dual energy X-ray absorptiometry (DXA) with antiresorptive (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 inform the model came from medical literature, epidemiological reports, and costing data sets. 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. Key aspects of the model were explored in sensitivity analyses. Due to relatively low effectiveness gains, the outcomes were primarily driven by the costs. The incremental cost per quality-adjusted life year gained was A$47,556 and A$253,000 for scenarios A and B, respectively. The numbers of fractures avoided were 56 and 77 per 1000 women, respectively. The results were most sensitive to the initial probability of osteoporosis, baseline risk of fracture, and cohort starting age. 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.
Keyword Antiresorptive therapy
Aromatase inhibitors
Cost-effectiveness
Dual-energy X-ray absorptiometry
Markov model
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Public Health Publications
 
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