Cost effectiveness of nasal calcitonin in postmenopausal women - Use of Cochrane collaboration methods for meta-analysis within economic evaluation

Objective: To assess the cost effectiveness of nasal calcitonin (Miacalcin((R))) compared with no therapy, alendronate or etidronate in the treatment of postmenopausal women with previous osteoporotic fracture. Design and setting: Meta-analysis followed by economic analysis. Perspective: A Canadian provincial Ministry of Health. Methods: The meta-analysis of randomised controlled clinical trials was based on the recommendations of the Cochrane Collaboration. Economic analysis was conducted within a Markov model using probabilities and costs derived from Canadian sources. Results: The mete-analysis found evidence of the positive effect of both nasal calcitonin and alendronate in reducing the risks of hip, wrist and vertebral fractures in postmenopausal women. However, there was a lack of evidence of the effect of etidronate on hip and wrist fractures. For a 65-year-old woman, with 5 years' therapy, the incremental cost per quality-adjusted life-year (QALY) gained for nasal calcitonin was 46 500 Canadian dollars ($Can) compared with no therapy and $Can32 600 compared with etidronate (1998 values). Comparison with alendronate was highly sensitive to the inclusion of one specific trial. Conclusions: Given the results of the analysis, based on current evidence, nasal calcitonin can be considered at the margins of being cost effective when compared with no therapy. Compared with active therapy, nasal calcitonin can be considered more cost effective than etidronate, but its cost effectiveness versus alendronate is inconclusive.