Cost-effective osteoporosis treatment thresholds: the United States perspective
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A United States-specific cost-effectiveness analysis, which incorporated the cost and health consequences of clinical fractures of the hip, spine, forearm, shoulder, rib, pelvis and lower leg, was undertaken to identify the 10-year hip fracture probability required for osteoporosis treatment to be cost-effective for cohorts defined by age, sex, and race/ethnicity. A 3% 10-year risk of hip fracture was generally required for osteoporosis treatment to cost less than $60,000 per QALY gained.
Rapid growth of the elderly United States population will result in so many at risk of osteoporosis that economically efficient approaches to osteoporosis care warrant consideration.
A Markov-cohort model of annual United States age-specific incidence of clinical hip, spine, forearm, shoulder, rib, pelvis and lower leg fractures, costs (2005 US dollars), and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment ($600/yr drug cost for 5 years with 35% fracture reduction) by gender and race/ethnicity groups. To determine the 10-year hip fracture probability at which treatment became cost-effective, average annual age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until a cost of $60,000 per QALY gained was observed for treatment relative to no intervention.
Osteoporosis treatment was cost-effective when the 10-year hip fracture probability reached approximately 3%. Although the RR at which treatment became cost-effective varied markedly between genders and by race/ethnicity, the absolute 10-year hip fracture probability at which intervention became cost-effective was similar across race/ethnicity groups, but tended to be slightly higher for men than for women.
Application of the WHO risk prediction algorithm to identify individuals with a 3% 10-year hip fracture probability may facilitate efficient osteoporosis treatment.
- Cost-effective osteoporosis treatment thresholds: the United States perspective
Volume 19, Issue 4 , pp 437-447
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- National Osteoporosis Foundation
- Practice guidelines
- World Health Organization
- Industry Sectors
- Author Affiliations
- 1. Multidisciplinary Clinical Research Center in Musculoskeletal Diseases and The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH, USA
- 8. HB7505 Clinical Research, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH, 03756, USA
- 2. Division of Epidemiology, College of Medicine, Mayo Clinic, Rochester, MN, USA
- 3. Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
- 4. The Medical College of Wisconsin, Milwaukee, WI, USA
- 5. Department of Medicine, University of Chicago, Chicago, IL, USA
- 6. Division of Endocrinology, College of Medicine, Mayo Clinic, Rochester, MN, USA
- 7. Helen Hayes Hospital, Regional Bone Center, West Haverstraw, NY, USA