Cost-effective osteoporosis treatment thresholds in Greece.
A Greek-specific cost-effectiveness analysis determined the FRAX-based intervention thresholds. Assuming a willingness to pay of 30,000 <euro>, osteoporosis treatment is cost-effective in subjects under the age of 75 with 10-year probabilities for hip and major osteoporotic fractures of 2.5 and 10 %, respectively, while for older patients, the same thresholds are raised to 5 and 15 %.


BACKGROUND
The purpose of this study was to determine the FRAX calculated fracture probabilities at which therapeutic intervention can be considered as cost-effective in the Greek setting.


METHODS
A Markov cohort model was populated with Greek data, and quality-adjusted life years (QALYs) were used to calculate the cost-effective thresholds for an annual medication cost of 733.7 <euro> by gender and age. Average FRAX-based 10-year probabilities for both major osteoporotic and hip fractures were multiplied by the model-derived relative risk at which a cost of 30,000 <euro> for each QALY gained was observed for treatment versus to no intervention.


RESULTS
A biphasic intervention threshold model is supported by our findings. Osteoporosis treatment becomes cost-effective when absolute 10-year probabilities for hip and major osteoporotic fractures reach 2.5 and 10 %, respectively, among both men and women under the age of 75. For older subjects, the proposed intervention thresholds are raised to 5 and 15 % 10-year probability for hip and major osteoporotic fractures, respectively.


CONCLUSIONS
Cost-effective osteoporosis treatment may be facilitated in Greece if FRAX algorithm is used to identify subjects with 10-year probabilities for hip and major osteoporotic fractures of 2.5 and 10 %, under the age of 75, while for older patients, the relevant thresholds are 5 and 15 %, respectively.
Department of Endocrinology and Diabetes, 251 Hellenic Air Force General Hospital, Athens, Greece, makras@internet.gr.
P
P
Makras
K
K
Athanasakis
N
N
Boubouchairopoulou
S
S
Rizou
A D
AD
Anastasilakis
J
J
Kyriopoulos
G P
GP
Lyritis
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D006115:Greece / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D010024:Osteoporosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D018570:Risk Assessment / Q000379:methods; D012737:Sex Factors
D050071:Bone Density Conservation Agents