Table 4.

ICERs for Each Strategy, by Mean BMD Before ADT and Effectiveness of Alendronate^*

Mean BMD, g/cm2	Prevalence of Osteoporosis, %†	ICER, by Bone Loss Prevented by Alendronate, $/QALY
		100%‡		75%			50%
		Test and Selective Alendronate Therapy	No Test and Universal Alendronate Therapy	Test and Selective Alendronate Therapy	No Test and Universal Alendronate Therapy		Test and Selective Alendronate Therapy	No Test and Universal Alendronate Therapy
0.8069	5	123 300	271 700	185 900	391 500	312 100		615 600
0.7540‡	11	66 800	178 700	112 700	257 400	205 400		417 200
0.7017	20	44 000	104 800	83 200	161 500	162 200		276 400
0.6601	30	35 200	60 500	71 700	104 200	145 600		192 600
0.6246	40	Dominated§	30 500	Dominated§	65 600	Dominated§		136 400
0.5915	50	Dominated§	17 500	Dominated§	48 900	Dominated§		112 300

BMD = bone mineral density; ICER = incremental cost-effectiveness ratio; QALY quality-adjusted life-year.

^*ICER was measured by cost per QALY gained. The no test–no alendronate strategy was the reference strategy because it was the least costly, viable (nondominated) option. The strategy was considered cost-effective if its ICER was less than $100 000 per QALY gained (32, 63).

^†Assumed a normal distribution of BMD and 0.5915 g/cm² as a BMD cut-off value for the diagnosis of osteoporosis.

^‡Base-case assumptions.

^§Universal alendronate therapy without a BMD test dominated this strategy by simple dominance because it was less effective and more costly.