Abstract
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.