Which Bisphosphonate? It's the Compliance!: Decision Analysis.
BACKGROUND
The best options of several bisphosphonates for prevention of osteoporotic fractures in postmenopausal women remain controversial. We determined which bisphosphonate provides better efficacy in prevention of osteoporotic fractures using a decision analysis tool, in terms of quality of life.


METHODS
A decision analysis model was constructed containing final outcome score and the probability of vertebral and hip fracture within 1 year. Final outcome was defined as health-related quality of life, and was used as an utility in the decision tree. Probabilities were obtained by literature review, and health-related quality of life was evaluated by consensus committee. A roll back tool was used to determine the best bisphosphonate, and sensitivity analysis was performed to compensate for decision model uncertainty.


RESULTS
The decision model favored bisphosphonate with higher compliance in terms of quality of life. In one-way sensitivity analysis, ibandronate was more beneficial than the others, when probability of compliance on ibandronate was above 0.589.


CONCLUSIONS
In terms of quality of life, the decision analysis model showed that compliance was most important for patients in real world, regardless of type of bisphosphonate.
Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea.
You Jin
YJ
Lee
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Chan Ho
CH
Park
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Young-Kyun
YK
Lee
Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
Yong-Chan
YC
Ha
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Kyung-Hoi
KH
Koo
Diphosphonates; Fractures bone; Osteoporosis postmenopausal; Patient compliance