Intervention thresholds for osteoporosis in the UK.
The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in women based on data from the UK. We modelled the effects of an intervention costing pound 350 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35% followed by a waning of effect (offset time) for a further 5 years. Sensitivity analyses included a range of treatment duration (3-10 years), intervention costs (pound 300-400/year) and offset times (0-15 years). Data on costs and risks were from the UK. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of pound 30,000/QALY gained was used. With the base case ( pound 350 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.1% at the age of 50 years to 9.0% at the age of 85 years. Intervention thresholds were sensitive to the assumed costs and offset time. 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. Cost-effective scenarios were found for women at the threshold for osteoporosis from the age of 60 years. Treatment of established osteoporosis was cost-effective irrespective of age. 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 from the UK at moderately increased fracture risk.
Kanis
John A
JA
Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, Sheffield, UK. w.j.Pontefract@shef.ac.uk
Borgstrom
Frederik
F
Zethraeus
Niklas
N
Johnell
Olof
O
Oden
Anders
A
Jönsson
Bengt
B
D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D006620:Hip Fractures / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy; D011336:Probability; D012680:Sensitivity and Specificity; D006113:United Kingdom