Current Rheumatology Reports

, Volume 9, Issue 1, pp 50–56

Cost-effectiveness modeling research of pharmacologic therapy to prevent osteoporosis-related fractures

Article

Abstract

Osteoporotic fractures are common among postmenopausal women and elderly men, and they cause substantial direct medical costs and loss of quality of life. The potential costs of widespread intervention strategies to reduce the incidence of fractures are also quite high. Therefore, the cost-effectiveness of such interventions is highly significant to large-scale health insurers and healthcare systems. Most modeling studies to date have examined the cost-effectiveness of pharmacologic treatment for subsets of postmenopausal women selected on the basis of bone mineral density and/or prevalent vertebral fracture. They generally suggest that oral bisphosphonates and raloxifene are cost-effective therapies for these subsets. Increasingly, modeling studies of treatments for those selected on the basis of absolute fracture risk rather than bone density criteria are being done to establish absolute fracture risk thresholds at which various treatments are cost-effective.

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References and Recommended Reading

  1. 1.
    Riggs BL, Melton LJ 3rd: The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995, 17(5 Suppl):505S–511S.PubMedCrossRefGoogle Scholar
  2. 2.
    Melton LJ 3rd, Johnell O, Lau E, et al.: Osteoporosis and the global competition for health care resources. J Bone Miner Res 2004, 19:1055–1058.PubMedCrossRefGoogle Scholar
  3. 3.
    Garcia-Altes A, Ondategui-Parra S, Neumann PJ: Cross-national comparison of technology assessment processes. Int J Technol Assess Health Care 2004, 20:300–310.PubMedGoogle Scholar
  4. 4.
    Bloom BS: Use of formal benefit/cost evaluations in health system decision making. Am J Manag Care 2004, 10:329–335.PubMedGoogle Scholar
  5. 5.
    Garcia-Altes A, Ondategui-Parra S, Neumann PJ: Cross-national comparison of technology assessment processes. Int J Technol Assess Health Care 2004, 20:300–310.PubMedGoogle Scholar
  6. 6.
    Bloom BS: Use of formal benefit/cost evaluations in health system decision making. Am J Manag Care 2004, 10:329–335.PubMedGoogle Scholar
  7. 7.
    Neumann PJ, Rosen AB, Weinstein MC: Medicare and cost-effectiveness analysis. N Engl J Med 2005, 353:1516–1522.PubMedCrossRefGoogle Scholar
  8. 8.
    Buxton MJ, Drummond MF, Van Hout BA, et al.: Modelling in economic evaluation: an unavoidable fact of life. Health Econ 1997, 6:217–227.PubMedCrossRefGoogle Scholar
  9. 9.
    Sonnenberg FA, Beck JR: Markov models in medical decision making: a practical guide. Med Decis Making 1993, 13:322–338.PubMedCrossRefGoogle Scholar
  10. 10.
    Zethraeus N, Ben Sedrine W, Caulin F, et al.: Models for assessing the cost-effectiveness of the treatment and prevention of osteoporosis. Osteoporos Int 2002, 13:841–857.PubMedCrossRefGoogle Scholar
  11. 11.
    Fleurence RL, Iglesias CP, Torgerson DJ: Economic evaluations of interventions for the prevention and treatment of osteoporosis: a structured review of the literature. Osteoporos Int 2006, 17:29–40.PubMedCrossRefGoogle Scholar
  12. 12.
    Johnell O, Jonsson B, Jonsson L, Black D: Cost effectiveness of alendronate (fosamax) for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics 2003, 21:305–314.PubMedCrossRefGoogle Scholar
  13. 13.
    Kanis JA, Borgstrom F, Johnell O, Jonsson B: Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women. Osteoporos Int 2004, 15:862–871.PubMedCrossRefGoogle Scholar
  14. 14.
    Stevenson M, Lloyd Jones M, De Nigris E, et al.: A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. Health Technol Assess 2005, 9:1–160.PubMedGoogle Scholar
  15. 15.
    Borgstrom F, Carlsson A, Sintonen H, et al.: The cost-effectiveness of risedronate in the treatment of osteoporosis: an international perspective. Osteoporos Int 2006, 17:996–1007.PubMedCrossRefGoogle Scholar
  16. 16.
    Borgstrom F, Johnell O, Jonsson B, et al.: Cost effectiveness of alendronate for the treatment of male osteoporosis in Sweden. Bone 2004, 34:1064–1071.PubMedCrossRefGoogle Scholar
  17. 17.
    Schousboe JT, Ensrud KE, Nyman JA, et al.: Universal bone densitometry screening combined with alendronate therapy for those diagnosed with osteoporosis is high cost-effective for elderly women. J Am Geriatr Soc 2005, 53:1697–1704.PubMedCrossRefGoogle Scholar
  18. 18.
    Pfister AK, Welch CA, Lester MD, et al.: Cost-effectiveness strategies to treat osteoporosis in elderly women. South Med J 2006, 99:123–131.PubMedCrossRefGoogle Scholar
  19. 19.
    Liu H, Michaud K, Nayak S, et al.: The cost-effectiveness of therapy with teriparatide and alendronate in women with severe osteoporosis. Arch Intern Med 2006, 166:1209–1217.PubMedCrossRefGoogle Scholar
  20. 20.
    Lundkvist J, Johnell O, Cooper C, Sykes D: Economic evaluation of parathyroid hormone (PTH) in the treatment of osteoporosis in postmenopausal women. Osteoporos Int 2006, 17:201–211.PubMedCrossRefGoogle Scholar
  21. 21.
    Schousboe JT, Nyman JA, Kane RL, Ensrud KE: Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med 2005, 142:734–741.PubMedGoogle Scholar
  22. 22.
    Schousboe JT, Ensrud KE, Nyman JA, et al.: Potential cost-effective use of spine radiographs to detect vertebral deformity and select osteopenic post-menopausal women for amino-bisphosphonate therapy. Osteoporos Int 2005, 16:1883–1893.PubMedCrossRefGoogle Scholar
  23. 23.
    Schousboe JT, Ensrud KE, Nyman JA, et al.: Cost-effectiveness of vertebral fracture assessment to detect prevalent vertebral deformity and select postmenopausal women with a femoral neck T-score>−2.5 for alendronate therapy: a modeling study. J Clin Densitom 2006, 9:133–143.PubMedCrossRefGoogle Scholar
  24. 24.
    Schousboe JT, Bauer DC, Nyman JA, et al.: Potential for bone turnover markers to cost-effectively identify and select post-menopausal osteopenic women at high risk of fracture for bisphosphonate therapy. Osteoporos Int 2006, Epub ahead of print.Google Scholar
  25. 25.
    Kanis JA, Johnell O, De Laet C, et al.: International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 2002, 17:1237–1244.PubMedCrossRefGoogle Scholar
  26. 26.
    Borgstrom F, Johnell O, Kanis JA, et al.: Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden: an economic evaluation based on the MORE study. Pharmacoeconomics 2004, 22:1153–1165.PubMedCrossRefGoogle Scholar
  27. 27.
    Kanis JA, Borgstrom F, Johnell O, et al.: Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study. Osteoporos Int 2005, 16:15–25.PubMedCrossRefGoogle Scholar
  28. 28.
    Christensen PM, Brixen K, Gyrd-Hansen D, Kristiansen IS: Cost-effectiveness of alendronate in the prevention of osteoporotic fractures in Danish women. Basic Clin Pharmacol Toxicol 2005, 96:387–396.PubMedCrossRefGoogle Scholar
  29. 29.
    Kanis JA, Dawson A, Oden A, et al.: Cost-effectiveness of preventing hip fracture in the general female population. Osteoporos Int 2001, 12:356–361.PubMedCrossRefGoogle Scholar
  30. 30.
    Jonsson B, Christiansen C, Johnell O, Hedbrandt J: Cost-effectiveness of fracture prevention in established osteoporosis. Osteoporos Int 1995, 5:136–142.PubMedCrossRefGoogle Scholar
  31. 31.
    Jonsson B, Kanis J, Dawson A, et al.: Effect and offset of effect of treatments for hip fracture on health outcomes. Osteoporos Int 1999, 10:193–199.PubMedCrossRefGoogle Scholar
  32. 32.
    Kanis JA, Borgstrom F, Zethraeus N, et al.: Intervention thresholds for osteoporosis in the UK. Bone 2005, 36:22–32.PubMedCrossRefGoogle Scholar
  33. 33.
    Kanis JA, Johnell O, Oden A, et al.: Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden. Osteoporos Int 2005, 16:6–14.PubMedCrossRefGoogle Scholar
  34. 34.
    Borgstrom F, Johnell O, Kanis JA, et al.: At what hip fracture risk is it cost-effective to treat? International intervention thresholds for the treatment of osteoporosis. Osteoporos Int 2006, 17:1459–1471.PubMedCrossRefGoogle Scholar
  35. 35.
    Sachs JD: Macroeconomics and Health: Investing in Health for Economic Development. Geneva: World Health Organization; 2001.Google Scholar
  36. 36.
    Cummings SR, Black DM, Thompson DE, et al.: Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998, 280:2077–2082.PubMedCrossRefGoogle Scholar
  37. 37.
    McClung MR, Geusens P, Miller PD, et al.: Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 2001, 344:333–340.PubMedCrossRefGoogle Scholar
  38. 38.
    Salkeld G, Cameron ID, Cumming RG, et al.: Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ 2000, 320:341–346.PubMedCrossRefGoogle Scholar
  39. 39.
    Tosteson AN, Gabriel SE, Grove MR, et al.: Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int 2001, 12:1042–1049.PubMedCrossRefGoogle Scholar
  40. 40.
    Merlino LA, Bagchi I, Taylor TN, et al.: Preference for fractures and other glucocorticoid-associated adverse effects among rheum atoid arthritis patients. Med Decis Making 2001, 21:122–132.PubMedCrossRefGoogle Scholar
  41. 41.
    Kanis JA, Johnell O, Oden A, et al.: The risk and burden of vertebral fractures in Sweden. Osteoporos Int 2004, 15:20–26.PubMedCrossRefGoogle Scholar
  42. 42.
    Borgstrom F, Zethraeus N, Johnell O, et al.: Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 2006, 17:637–650.PubMedCrossRefGoogle Scholar
  43. 43.
    Solomon DH, Avorn J, Katz JN, et al.: Compliance with osteoporosis medications. Arch Intern Med 2005, 165:2414–2419.PubMedCrossRefGoogle Scholar
  44. 44.
    Recker RR, Gallagher R, MacCosbe PE: Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 2005, 80:856–861.PubMedCrossRefGoogle Scholar
  45. 45.
    Carder PC, Vuckovic N, Green CA: Negotiating medications: patient perceptions of long-term medication use. J Clin Pharm Ther Oct 2003, 28:409–417.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Park Nicollet Osteoporosis CenterPark Nicollet Health ServicesMinneapolisUSA

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