Date of Graduation


Document Type


Degree Type



School of Pharmacy


Pharmaceutical Sciences

Committee Chair

Suresh Madhavan.


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 ≤ risk < 0.3), and high (risk ≥ 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.