{"id":{"repo_id":"wvu","oai_identifier":"oai:researchrepository.wvu.edu:etd-2389"},"canonical_url":"https://search.dev.ndltd.org/etd/wvu/oai:researchrepository.wvu.edu:etd-2389","repository":{"repo_id":"wvu","name":"West Virginia University","base_url":"https://researchrepository.wvu.edu/do/oai/"},"display":{"title":"Economic evaluation of three preventive drug therapies for osteoporotic fractures among women at different risk levels","abstract":"Objective. To evaluate cost-effectiveness (CE) of three drug therapies for preventing osteoporotic fractures in postmenopausal women from a state Medicaid Program perspective using the estimated risk distribution in the study population. The three therapies are: hormone replacement therapy (HRT), alendronate, and raloxifene. Methods. A hypothetical cohort of white women aged 45--85 years, postmenopausal, and without past incidence of osteoporotic fractures was treated with one of the three alternatives, and tracked over 3 years in a decision model. The CE ratio was defined as the treatment costs [e.g., medications, monitoring, adverse events (AE)] divided by the number of fractures averted. Treatment Willingness-To-Continue (WTC) rate was also considered. Data were collected from literature, expert panel survey, Medicaid claims data, and a risk survey in the study population. Monte Carlo simulations were conducted (distributions used: background risk, cost, and risk reduction rate). Risk or probability of osteoporotic fracture was also divided into three strata: low (risk < 0.1), medium (0.1 &le; risk < 0.3), and high (risk &ge; 0.3). Results. Compared to no therapy, the expected CE of HRT was {dollar}29,119 per fracture averted, alendronate: {dollar}35,101, and raloxifene: {dollar}39,760. The incremental CE was {dollar}42,181 for alendronate (relative to HRT) and {dollar}85,509 for raloxifene (relative to alendronate). The incremental CE of alendronate and raloxifene were {dollar}151,981 and {dollar}697,270 among women with low risk (43% of the sample), compared to {dollar}11,099 and {dollar}34,017 respectively among high-risk women (26% of the sample). CE was not sensitive to discount rate and AE probabilities. Conclusions. HRT is the most cost-effective strategy even though it may have relatively high monitoring and AE costs, and low WTC rate. The significant decrease in marginal costs of Alendronate and Raloxifene in high-risk women indicates an economic condition to use these two drugs. The study provides a framework to make risk-appropriate coverage decisions for chemo-preventive agents.","abstract_html":"Objective. To evaluate cost-effectiveness (CE) of three drug therapies for preventing osteoporotic fractures in postmenopausal women from a state Medicaid Program perspective using the estimated risk distribution in the study population. The three therapies are: hormone replacement therapy (HRT), alendronate, and raloxifene. Methods. A hypothetical cohort of white women aged 45--85 years, postmenopausal, and without past incidence of osteoporotic fractures was treated with one of the three alternatives, and tracked over 3 years in a decision model. The CE ratio was defined as the treatment costs [e.g., medications, monitoring, adverse events (AE)] divided by the number of fractures averted. Treatment Willingness-To-Continue (WTC) rate was also considered. Data were collected from literature, expert panel survey, Medicaid claims data, and a risk survey in the study population. Monte Carlo simulations were conducted (distributions used: background risk, cost, and risk reduction rate). Risk or probability of osteoporotic fracture was also divided into three strata: low (risk &lt; 0.1), medium (0.1 &amp;le; risk &lt; 0.3), and high (risk &amp;ge; 0.3). Results. Compared to no therapy, the expected CE of HRT was {dollar}29,119 per fracture averted, alendronate: {dollar}35,101, and raloxifene: {dollar}39,760. The incremental CE was {dollar}42,181 for alendronate (relative to HRT) and {dollar}85,509 for raloxifene (relative to alendronate). The incremental CE of alendronate and raloxifene were {dollar}151,981 and {dollar}697,270 among women with low risk (43% of the sample), compared to {dollar}11,099 and {dollar}34,017 respectively among high-risk women (26% of the sample). CE was not sensitive to discount rate and AE probabilities. Conclusions. HRT is the most cost-effective strategy even though it may have relatively high monitoring and AE costs, and low WTC rate. The significant decrease in marginal costs of Alendronate and Raloxifene in high-risk women indicates an economic condition to use these two drugs. The study provides a framework to make risk-appropriate coverage decisions for chemo-preventive agents.","abstract_has_math":false,"creators":["Gao, Xin"],"institution":null,"degree_name":"PhD","degree_level":"Dissertation","degree_discipline":"Pharmaceutical Sciences","degree_department":null,"school":null,"contributors":["Suresh Madhavan."],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2001,"date_issued":"2001-08-01T07:00:00Z","date_published":"2001-08-01T07:00:00Z","updated_at":"2026-07-24T06:15:40Z","subjects":["Pharmaceutical sciences","Health care management","Commerce-Business"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["https://researchrepository.wvu.edu/etd/1386"],"render_values":[{"text":"https://researchrepository.wvu.edu/etd/1386","href":"https://researchrepository.wvu.edu/etd/1386","code":true}]}]},"links":{"outbound_url":"https://doi.org/10.33915/etd.1386","outbound_label":"DOI","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Suresh Madhavan."]},{"key":"dc:creator","label":"Author","values":["Gao, Xin"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.available","label":"Dc Date Available","values":["2019-01-17T08:00:00Z"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Pharmaceutical Sciences"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Dissertation"]},{"key":"thesis:degree_name","label":"Degree Name","values":["PhD"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Pharmaceutical sciences","Health care management","Commerce-Business"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://doi.org/10.33915/etd.1386","https://researchrepository.wvu.edu/etd/1386"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Objective. To evaluate cost-effectiveness (CE) of three drug therapies for preventing osteoporotic fractures in postmenopausal women from a state Medicaid Program perspective using the estimated risk distribution in the study population. The three therapies are: hormone replacement therapy (HRT), alendronate, and raloxifene. Methods. A hypothetical cohort of white women aged 45--85 years, postmenopausal, and without past incidence of osteoporotic fractures was treated with one of the three alternatives, and tracked over 3 years in a decision model. The CE ratio was defined as the treatment costs [e.g., medications, monitoring, adverse events (AE)] divided by the number of fractures averted. Treatment Willingness-To-Continue (WTC) rate was also considered. Data were collected from literature, expert panel survey, Medicaid claims data, and a risk survey in the study population. Monte Carlo simulations were conducted (distributions used: background risk, cost, and risk reduction rate). Risk or probability of osteoporotic fracture was also divided into three strata: low (risk < 0.1), medium (0.1 &le; risk < 0.3), and high (risk &ge; 0.3). Results. Compared to no therapy, the expected CE of HRT was {dollar}29,119 per fracture averted, alendronate: {dollar}35,101, and raloxifene: {dollar}39,760. The incremental CE was {dollar}42,181 for alendronate (relative to HRT) and {dollar}85,509 for raloxifene (relative to alendronate). The incremental CE of alendronate and raloxifene were {dollar}151,981 and {dollar}697,270 among women with low risk (43% of the sample), compared to {dollar}11,099 and {dollar}34,017 respectively among high-risk women (26% of the sample). CE was not sensitive to discount rate and AE probabilities. Conclusions. HRT is the most cost-effective strategy even though it may have relatively high monitoring and AE costs, and low WTC rate. The significant decrease in marginal costs of Alendronate and Raloxifene in high-risk women indicates an economic condition to use these two drugs. The study provides a framework to make risk-appropriate coverage decisions for chemo-preventive agents."]},{"key":"dc:title","label":"Title","values":["Economic evaluation of three preventive drug therapies for osteoporotic fractures among women at different risk levels"]}]}],"canonical_facts":{"dc:contributor":["Suresh Madhavan."],"dc:creator":["Gao, Xin"],"dc:date.available":["2019-01-17T08:00:00Z"],"dc:description.abstract":["Objective. To evaluate cost-effectiveness (CE) of three drug therapies for preventing osteoporotic fractures in postmenopausal women from a state Medicaid Program perspective using the estimated risk distribution in the study population. The three therapies are: hormone replacement therapy (HRT), alendronate, and raloxifene. Methods. A hypothetical cohort of white women aged 45--85 years, postmenopausal, and without past incidence of osteoporotic fractures was treated with one of the three alternatives, and tracked over 3 years in a decision model. The CE ratio was defined as the treatment costs [e.g., medications, monitoring, adverse events (AE)] divided by the number of fractures averted. Treatment Willingness-To-Continue (WTC) rate was also considered. Data were collected from literature, expert panel survey, Medicaid claims data, and a risk survey in the study population. Monte Carlo simulations were conducted (distributions used: background risk, cost, and risk reduction rate). Risk or probability of osteoporotic fracture was also divided into three strata: low (risk < 0.1), medium (0.1 &le; risk < 0.3), and high (risk &ge; 0.3). Results. Compared to no therapy, the expected CE of HRT was {dollar}29,119 per fracture averted, alendronate: {dollar}35,101, and raloxifene: {dollar}39,760. The incremental CE was {dollar}42,181 for alendronate (relative to HRT) and {dollar}85,509 for raloxifene (relative to alendronate). The incremental CE of alendronate and raloxifene were {dollar}151,981 and {dollar}697,270 among women with low risk (43% of the sample), compared to {dollar}11,099 and {dollar}34,017 respectively among high-risk women (26% of the sample). CE was not sensitive to discount rate and AE probabilities. Conclusions. HRT is the most cost-effective strategy even though it may have relatively high monitoring and AE costs, and low WTC rate. The significant decrease in marginal costs of Alendronate and Raloxifene in high-risk women indicates an economic condition to use these two drugs. The study provides a framework to make risk-appropriate coverage decisions for chemo-preventive agents."],"dc:identifier":["https://doi.org/10.33915/etd.1386","https://researchrepository.wvu.edu/etd/1386"],"dc:subject":["Pharmaceutical sciences","Health care management","Commerce-Business"],"dc:title":["Economic evaluation of three preventive drug therapies for osteoporotic fractures among women at different risk levels"],"thesis:degree_discipline":["Pharmaceutical Sciences"],"thesis:degree_level":["Dissertation"],"thesis:degree_name":["PhD"]},"updated_at":"2026-07-24T06:15:40Z"}