title: Cost-effectiveness of osteoporosis interventions for 'incidental' vertebral fractures.
abstract: BACKGROUND
  Vertebral fractures detected "incidentally" by chest radiograph usually do not trigger osteoporosis treatment in older patients. In a 3-arm controlled trial we reported that both physician-directed and enhanced (physician plus patient activation) interventions increased treatment rates more than 10-fold (15%-20% absolute increases) compared with usual care; the cost-effectiveness of these interventions is unknown.
  
  
  METHODS
  Incremental cost-effectiveness of these 2 interventions compared with usual care was assessed using a Markov decision-analytic model, populated with 1-year outcomes data and direct intervention costs from the trial. Costs were expressed in 2009 Canadian dollars and effectiveness based on quality-adjusted life years (QALYs) gained. The perspective was health care payer; horizon was projected lifetime; costs and benefits were discounted at 3%; and deterministic and probabilistic sensitivity analyses were conducted.
  
  
  RESULTS
  Per patient, the physician and enhanced interventions cost $34 and $42, respectively. Compared with usual care, for every 1000 patients exposed to the physican intervention there were 4 fewer fractures, 8 more QALYs gained, and $282,000 saved. Compared with physician interventions, for every 1000 patients exposed to enhanced interventions there were 6 fewer fractures, 6 more QALYs gained, and $339,000 saved. Both interventions dominated usual care and were cost-effective in ~80% of 10,000 probabilistic simulations. Although the enhanced intervention cost $8 more per patient, it still dominated the physician intervention and usual care, and was the most economically attractive option.
  
  
  CONCLUSIONS
  Pragmatic and inexpensive interventions directed at patients with incidentally detected vertebral fractures and their physicians are highly cost-effective at improving osteoporosis treatment, and in most circumstances also are cost-saving.
authors: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. me2.majumdar@ualberta.ca
authors: Sumit R
authors: SR
authors: Majumdar
authors: Douglas A
authors: DA
authors: Lier
authors: Finlay A
authors: FA
authors: McAlister
authors: Brian H
authors: BH
authors: Rowe
authors: Kerry
authors: K
authors: Siminoski
authors: David A
authors: DA
authors: Hanley
authors: Anthony S
authors: AS
authors: Russell
authors: Jeffrey A
authors: JA
authors: Johnson
mesh_terms: D000368:Aged; D019386:Alendronate / Q000191:economics / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D010024:Osteoporosis / Q000150:complications* / Q000188:drug therapy* / Q000191:economics; D011788:Quality of Life; D013131:Spine / Q000473:pathology*
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate