Cost-effective but clinically inappropriate: new NICE intervention thresholds in osteoporosis (Technology Appraisal 464)
To comment on the latest technology appraisal of the National Institute for Clinical Excellence (NICE) in osteoporosis.
Review of NICE Technology Appraisal (TA464) on bisphosphonate use in osteoporosis.
The NICE appraisal on bisphosphonate use in osteoporosis indicates that treatment with oral bisphosphonates may be instituted at a FRAX 10-year probability of major osteoporotic fracture above 1%. Implementation would mean that all women aged 50 years or older are deemed eligible for treatment, a position that would increase the burden of rare long-term side effects across the population.
Cost-effectiveness thresholds for low-cost interventions should not be used to set intervention thresholds but rather to validate the implementation of clinically driven intervention thresholds.
KeywordsCost-effectiveness FRAX Intervention thresholds National Institute for Clinical Excellence National Osteoporosis Guideline Group Osteoporosis
We are grateful to the Committee of Scientific Advisors and the Committee of National Societies of the International Osteoporosis Foundation (IOF) and the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) for their reviews and endorsement of this manuscript.
Compliance with ethical standards
Conflicts of interest
NCH has received consultancy/lecture fees/honoraria/grant funding from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, UCB, Consilient Healthcare and Internis Pharma. EVM has received consultancy/lecture fees/grant funding/honoraria from ActiveSignal, Amgen, AstraZeneca, Consilient Healthcare, Gilead, GSK, Hologic, Internis, Lilly, Medtronic, Merck, Novartis, Pfizer, Radius Pharmaceuticals, Roche, Sanofi-Aventis, Servier, Synexus, Tethys, UCB, Viiv, Warner Chilcott, I3 Innovus, Unilever. JAK reports grants from Amgen, Lilly and Radius Health, and consulting fees from Meda; he is the architect of FRAX but has no financial interest. JEC has received advisory and speaking fees from Gilead, speaking fees from Amgen, and is Chairman of NOGG. CC has received consultancy/lecture fees/honoraria/grant funding from AMGEN, GSK, Alliance for Better Bone Health, MSD, Eli Lilly, Pfizer, Novartis, Servier, Medtronic and Roche.
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