title: Potential cost-effectiveness for using patient decision aids to guide osteoporosis treatment.
abstract: We use a model to predict whether using a patient decision aid in patients considering bisphosphonate therapy would be a good use of health resources. We found that if the decision aid improved adherence, and only marginally increased time physicians needed with their patients, then the decision-aid would be cost-effective.
  
  
  
  Oral bisphosphonates have been shown to reduce the risk of osteoporotic fracture. Adherence is crucial but suboptimal. A recent study suggests that a patient decision aid, which facilitates shared decision-making, could be effective in increasing adherence to bisphosphonates. But decision aids come at a cost in terms of additional time spent with physicians. This study considers the emerging evidence on the role of patient decision aids in improving adherence to bisphosphonates and their potential costs to inform future decision-making and research priorities.
  
  
  
  We estimate the hypothetical cost-effectiveness of a patient decision aid detailing the benefits and risks of bisphosphonates for osteoporotic patients, from a Canadian healthcare perspective. A previously developed and validated Markov microsimulation model was adapted to include use of a patient decision aid to support the decision of whether to initiate bisphosphonate therapy, and subsequent influence on adherence and future fractures. We considered 2014 costs and benefits in terms of quality-adjusted life-years (QALYs).
  
  
  
  A patient decision aid that could improve treatment initiation rates or persistence (adherence) by 20 %, or a linear combination of the two, in osteoporotic women aged 70+ over a 3-year treatment period was found to have an incremental cost-effectiveness ratio below $50,000/QALY.
  
  
  
  Patient decision aids have the potential to be cost-effective in osteoporosis so long as they increase adherence under certain conditions. Funding further research on the long-term effectiveness and costs of a patient decision aid which outlines all treatment options for osteoporosis patients is justified.
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.|Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Penton
authors.affiliation: Department of Health Services Research, CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hiligsmann
authors.affiliation: Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.|Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Harrison
authors.affiliation: Department of Public Health, Epidemiology, and Health Economics, University of Liège, Liège, Belgium.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Reginster
authors.affiliation: Department of Internal Medicine, CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Boonen
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada. nick.bansback@ubc.ca.|School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. nick.bansback@ubc.ca.
authors.forename: N
authors.initials: N
authors.lastname: Bansback
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D055118:Medication Adherence; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000191:economics*; D019057:Quality-Adjusted Life Years
chemical_list: D004164:Diphosphonates
keywords: Adherence; Bisphosphonates; Cost-effectiveness; Osteoporosis; Patient decision aid; Shared decision-making