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Cost-effective osteoporosis treatment thresholds in Greece

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Abstract

Summary

A Greek-specific cost-effectiveness analysis determined the FRAX-based intervention thresholds. Assuming a willingness to pay of 30,000 €, 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 %.

Introduction

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 € 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 € 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.

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Conflicts of interest

P. Makras has received lecture fees and research grants from Amgen and lecture fees from Pfizer, Leo, Genesis, ELPEN, UniPharma, VIANEX. A.D. Anastasilakis has received lecture fees from Amgen. G.P. Lyritis has received lecture fees from Amgen, Servier, Merck, Eli Lilly. K. Athanasakis, N. Boubouchairopoulou, J. Kyriopoulos, and S. Rizou have nothing to disclose.

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Author notes

    Authors and Affiliations

    1. Department of Endocrinology and Diabetes, 251 Hellenic Air Force General Hospital, Athens, Greece

      P. Makras

    2. Department of Health Economics, National School of Public Health, Athens, Greece

      K. Athanasakis, N. Boubouchairopoulou & J. Kyriopoulos

    3. Hellenic Osteoporosis Foundation, Athens, Greece

      S. Rizou & G. P. Lyritis

    4. Department of Endocrinology, 424 Military Hospital, Thessaloniki, Greece

      A. D. Anastasilakis

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    1. P. Makras
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    Correspondence to P. Makras.

    Additional information

    Polyzois Makras and Konstantinos Athanasakis contributed equally to this paper.

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    Makras, P., Athanasakis, K., Boubouchairopoulou, N. et al. Cost-effective osteoporosis treatment thresholds in Greece. Osteoporos Int 26, 1949–1957 (2015). https://doi.org/10.1007/s00198-015-3055-8

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    • DOI: https://doi.org/10.1007/s00198-015-3055-8

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