Cost-Effectiveness of Fracture Prevention in Postmenopausal Women With Early Breast Cancer in China.

BACKGROUND

Aromatase inhibitors (AIs) significantly increase the risk of osteoporosis and related fractures in postmenopausal women with hormone receptor (HR)-positive early breast cancer (EBC), posing a substantial clinical and economic burden. Effective fracture prevention strategies are critical, especially in resource-constrained settings such as China.

METHODS

A Markov microsimulation model was developed to evaluate the cost-effectiveness of fracture prevention strategies for 60-year-old postmenopausal women with HR-positive EBC treated with AIs in China. Six strategies were compared: (a) no intervention, (b) one-time bone mineral density (BMD) screening followed by anti-osteoporotic medication for patients with osteoporosis or osteopenia, (c) annual BMD screening followed by anti-osteoporotic medication for patients with osteoporosis or osteopenia and (d) universal anti-osteoporotic medication without prior BMD screening. Outcomes included incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) gained versus China's willingness-to-pay (WTP) threshold (3 × GDP/capita = $38 223/QALY).

RESULTS

All interventions reduced fractures but increased costs versus no intervention. For women aged 60-64 years, one-time BMD screening followed by therapy for osteoporosis (T-score ≤ -2.5) achieved an ICER of $17 368/QALY, below the WTP threshold. Annual screening yielded marginally higher QALYs (+0.0096) but higher costs (+$895.09), resulting in an ICER exceeding $38 223/QALY. For women ≥ 65 years, both one-time screening for osteoporosis or osteopenia and universal therapy were cost-effective. Universal therapy dominated in high-risk subgroups (history of falls/fractures), achieving the highest QALY gains.

CONCLUSIONS

One-time BMD screening with selective alendronate for osteoporosis is cost-effective for Chinese women aged ≥ 60 receiving AIs, aligning with China's healthcare constraints. Universal therapy becomes favourable for older or high-risk subgroups. These data-driven findings support tailored strategies to optimise bone health management and resource allocation.