Cost-effective intervention thresholds against osteoporotic fractures based on FRAX® in Switzerland
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FRAX-based cost-effective intervention thresholds in the Swiss setting were determined. Assuming a willingness to pay at 2× Gross Domestic Product per capita, an intervention aimed at reducing fracture risk in women and men with a 10-year probability for a major osteoporotic fracture at or above 15% is cost-effective.
The fracture risk assessment algorithm FRAX® has been recently calibrated for Switzerland. The aim of the present analysis was to determine FRAX-based fracture probabilities at which intervention becomes cost-effective.
A previously developed and validated state transition Markov cohort model was populated with Swiss epidemiological and cost input parameters. Cost-effective FRAX-based intervention thresholds (cost-effectiveness approach) and the cost-effectiveness of intervention with alendronate (original molecule) in subjects with a FRAX-based fracture risk equivalent to that of a woman with a prior fragility fracture and no other risk factor (translational approach) were calculated based on the Swiss FRAX model and assuming a willingness to pay of 2 times Gross Domestic Product per capita for one Quality-adjusted Life-Year.
In Swiss women and men aged 50 years and older, drug intervention aimed at decreasing fracture risk was cost-effective with a 10-year probability for a major osteoporotic fracture at or above 13.8% (range 10.8% to 15.0%) and 15.1% (range 9.9% to 19.9%), respectively. Age-dependent variations around these mean values were modest. Using the translational approach, treatment was cost-effective or cost-saving after the age 60 years in women and 55 in men who had previously sustained a fragility fracture. Using the latter approach leads to considerable underuse of the current potential for cost-effective interventions against fractures.
Using a FRAX-based intervention threshold of 15% for both women and men should permit cost-effective access to therapy to patients at high fracture probability based on clinical risk factors and thereby contribute to further reduce the growing burden of osteoporotic fractures in Switzerland.
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- Cost-effective intervention thresholds against osteoporotic fractures based on FRAX® in Switzerland
Volume 23, Issue 11 , pp 2579-2589
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- Intervention thresholds
- 10-year fracture probability
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- Author Affiliations
- 1. Osteoporosis Policlinic, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- 5. University Hospital and University of Bern, CH-3010, Bern, Switzerland
- 2. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- 3. LIME/MMC, Karolinska Institutet, Stockholm, Sweden
- 4. Division of Bone Diseases, Department of Medical Specialties, University Hospital and Medical Faculty of Geneva, Geneva, Switzerland