Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden.
The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in men and women, based on data from Sweden. We modeled the effects of a treatment costing $500 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35% followed by a waning of effect for a further 5 years. Sensitivity analyses included a range of effectiveness (10-50%) and a range of intervention costs ($200-500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of approximately $45,000/QALY gained was used. Cost of added years was included in a sensitivity analysis. With the base case ($500 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for cost-effectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted cost-effectively to individuals at moderately increased fracture risk.
Kanis
John A
JA
Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. w.j.Pontefract@shef.ac.uk
Johnell
Olof
O
Oden
Anders
A
Borgstrom
Frederik
F
Johansson
Helena
H
De Laet
Chris
C
Jönsson
Bengt
B
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis / Q000379:methods; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D006620:Hip Fractures / Q000517:prevention & control; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology