Using economics to prioritize research: a case study of randomized trials for the prevention of hip fractures due to osteoporosis.
OBJECTIVE
To assess the role of economics, in combination with clinical judgement, for setting research priorities, using osteoporosis prevention (and, as a result, hip fracture prevention) as an example.


METHODS
Modelling the cost and effectiveness of each of six potential interventions to prevent hip fractures over the 5-year length of a randomized trial (vitamin D injection; thiazide diuretics; hormone replacement therapy; oral calcium and vitamin D; calcium alone; calcitonin). Drug costs were derived from the Monthly Index of Medical Specialties (MIMS); averted fracture costs and estimates of effectiveness were derived from published sources.


RESULTS
Vitamin D injection proved to be the most potentially cost-effective treatment with a cost-effectiveness ratio of 584 Pounds. If averted costs are included, this leads to a saving of 9,176,496 Pounds per 100,000 women treated. By contrast, the most expensive therapy was calcitonin (marginal cost-effectiveness ratio of 433,548 Pounds). This suggests that priority should be given to trials assessing the effectiveness of vitamin D injections.


CONCLUSIONS
Relatively simple economic modelling exercises can inform research priorities and could help optimize the use of scarce research resources.
Torgerson
D
D
National Primary Care Research and Development Centre, Centre for Health Economics, University of York, UK.
Donaldson
C
C
Reid
D
D
D001581:Benzothiadiazines; D002116:Calcitonin / Q000191:economics / Q000627:therapeutic use; D002118:Calcium / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004232:Diuretics; D015914:Estrogen Replacement Therapy / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006292:Health Priorities; D006302:Health Services Research / Q000191:economics*; D006620:Hip Fractures / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D017059:Models, Econometric; D010024:Osteoporosis / Q000150:complications* / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D012109:Research Support as Topic / Q000191:economics*; D049993:Sodium Chloride Symporter Inhibitors / Q000191:economics / Q000627:therapeutic use; D006113:United Kingdom; D014807:Vitamin D / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use
D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D014807:Vitamin D; D002116:Calcitonin; D002118:Calcium