A Merck representative visits your office and tells you that Fosamax® (alendronate) will decrease the incidence of repeat hip fractures by 50% over 3 years. That excites you because you have 20 elderly women and 5 elderly men who already have a hip fracture. Look up Black's study in  Lancet  (1996) and find that fracture occurs in 2.2% of patients receiving placebo and 1.1% of patients receiving Fosamax®. Now:

What % is the Experimental Event Rate (EER)?

What % is the control event rate (CER)?

What is Absolute Risk Reduction (ARR)?

Calculate the NNT. Use 100 as a numerator. Don't worry about a negative or minus sign result. Example: 1.1-2.2 = 1.1 and not -1.1 when calculating NNT.

Go to  Epocrates Online  (**if you can't find the costs on this site, you can use another site, for example Walgreens, but  you must  indicate  which site and cite and reference  the website in your answer) and determine the cost of  Fosamax ®  and  alendronate  , the generic of Fosamax®,

The dosage for both is  one  70 mg pill orally once a week  . Also, note that Fosamax is available in multiple doses for different routes. Show your actual calculations/math so we can know what you did right and what you did wrong.

Using the NNT and cost of Fosamax and alendronate you calculated above, use the Cost of Prevention of Events (COPE) calculation (p. 331 in the textbook) to determine how much it costs to prevent a hip fracture over 3 years. Do this  for both  Fosamax and alendronate.

What does the COPE calculation tell you?

Which medication are you most likely to prescribe and why?

Is this more significant than simply talking about a 50% reduction in hip fractures?