title: An economic evaluation: Simulation of the cost-effectiveness and cost-utility of universal prevention strategies against osteoporosis-related fractures.
abstract: A patient-level Markov decision model was used to simulate a virtual cohort of 500,000 women 40 years old and over, in relation to osteoporosis-related hip, clinical vertebral, and wrist bone fractures events. Sixteen different screening options of three main scenario groups were compared: (1) the status quo (no specific national prevention program); (2) a universal primary prevention program; and (3) a universal screening and treatment program based on the 10-year absolute risk of fracture. The outcomes measured were total directs costs from the perspective of the public health care system, number of fractures, and quality-adjusted life-years (QALYs). Results show that an option consisting of a program promoting physical activity and treatment if a fracture occurs is the most cost-effective (CE) (cost/fracture averted) alternative and also the only cost saving one, especially for women 40 to 64 years old. In women who are 65 years and over, bone mineral density (BMD)-based screening and treatment based on the 10-year absolute fracture risk calculated using a Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool is the best next alternative. In terms of cost-utility (CU), results were similar. For women less than 65 years old, a program promoting physical activity emerged as cost-saving but BMD-based screening with pharmacological treatment also emerged as an interesting alternative. In conclusion, a program promoting physical activity is the most CE and CU option for women 40 to 64 years old. BMD screening and pharmacological treatment might be considered a reasonable alternative for women 65 years old and over because at a healthcare capacity of $50,000 Canadian dollars ($CAD) for each additional fracture averted or for one QALY gained its probabilities of cost-effectiveness compared to the program promoting physical activity are 63% and 75%, respectively, which could be considered socially acceptable. Consideration of the indirect costs could change these findings.
authors.affiliation: Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Québec, Québec, Canada.
authors.forename: Léon
authors.initials: L
authors.lastname: Nshimyumukiza
authors.forename: Audrey
authors.initials: A
authors.lastname: Durand
authors.forename: Mathieu
authors.initials: M
authors.lastname: Gagnon
authors.forename: Xavier
authors.initials: X
authors.lastname: Douville
authors.forename: Suzanne
authors.initials: S
authors.lastname: Morin
authors.forename: Carmen
authors.initials: C
authors.lastname: Lindsay
authors.forename: Julie
authors.initials: J
authors.lastname: Duplantie
authors.forename: Christian
authors.initials: C
authors.lastname: Gagné
authors.forename: Sonia
authors.initials: S
authors.lastname: Jean
authors.forename: Yves
authors.initials: Y
authors.lastname: Giguère
authors.forename: Sylvie
authors.initials: S
authors.lastname: Dodin
authors.forename: François
authors.initials: F
authors.lastname: Rousseau
authors.forename: Daniel
authors.initials: D
authors.lastname: Reinharz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000191:economics; D058866:Osteoporotic Fractures / Q000150:complications / Q000191:economics* / Q000517:prevention & control* / Q000628:therapy