Cost-effectiveness of multifaceted evidence implementation programs for the prevention of glucocorticoid-induced osteoporosis.
CONCLUSIONS
Using a computer simulation model, we determined that an intervention aimed at improving the management of glucocorticoid-induced osteoporosis is likely to be cost-effective to third-party health insurers only if it focuses on individuals with very high fracture risk and the proportion of prescriptions for generic bisphosphonates increases substantially.


BACKGROUND
The purpose of this study is to determine whether an evidence implementation program (intervention) focused on increasing appropriate management of glucocorticoid-induced osteoporosis (GIOP) might be cost-effective compared with current practice (no intervention) from the perspective of a third-party health insurer.


METHODS
We developed a Markov microsimulation model to determine the cost-effectiveness of the intervention. The hypothetical patient cohort was of current chronic glucocorticoid users 50-65 years old and 70% female. Model parameters were derived from published literature, and sensitivity analyses were performed.


RESULTS
The intervention resulted in incremental cost-effectiveness ratios (ICERs) of $298,000 per quality adjusted life year (QALY) and $206,000 per hip fracture averted. If the cohort's baseline risk of fracture was increased by 50% (10-year cumulative incidence of hip fracture of 14%), the ICERs improved significantly: $105,000 per QALY and $137,000 per hip fracture averted. The ICERs improved significantly if the proportion of prescriptions for generic bisphosphonates was increased to 75%, with $113,000 per QALY and $77,900 per hip fracture averted.


CONCLUSIONS
Evidence implementation programs for the management of GIOP are likely to be cost-effective to third-party health insurers only if they are targeted at individuals with a very high risk of fracture and the proportion of prescriptions for less expensive generic bisphosphonates increases substantially.
Beukelman
T
T
University of Alabama at Birmingham, Deep South Musculoskeletal Center for Education and Research on Therapeutics, Birmingham, AL 35294-3408, USA. tbeukelman@peds.uab.edu
Saag
K G
KG
Curtis
J R
JR
Kilgore
M L
ML
Pisu
M
M
D000368:Aged; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004164:Diphosphonates / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D010024:Osteoporosis / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D058866:Osteoporotic Fractures / Q000191:economics / Q000517:prevention & control; D019057:Quality-Adjusted Life Years; D057170:Translational Research, Biomedical; D014481:United States
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids