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Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA

Abstract

Summary

We developed a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women without prior major osteoporotic fractures over a lifetime horizon. At ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a conventionally accepted threshold compared with bisphosphonates alone.

Introduction

The purpose of this study was to examine the cost-effectiveness of the combined strategy of oral bisphosphonate therapy for 5 years and falls prevention exercise for 1 year compared with either strategy in isolation.

Methods

We calculated incremental cost-effectiveness ratios [ICERs] (2014 US dollars per quality-adjusted life year [QALY]), using a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women with different starting ages (65, 70, 75, and 80) without prior history of hip, vertebral, or wrist fractures over a lifetime horizon from the societal perspective.

Results

At ages 65, 70, 75, and 80, the combined strategy had ICERs of $202,020, $118,460, $46,870, and $17,640 per QALY, respectively, compared with oral bisphosphonate therapy alone. The combined strategy provided better health at lower cost than falls prevention exercise alone at ages 70, 75, and 80. In deterministic sensitivity analyses, results were particularly sensitive to the change in the opportunity cost of participants’ time spent exercising. In probabilistic sensitivity analyses, the probabilities of the combined strategy being cost-effective compared with the next best alternative increased with age, ranging from 35 % at age 65 to 48 % at age 80 at a willingness-to-pay of $100,000 per QALY.

Conclusions

Among community-dwelling US white women ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a willingness-to-pay of $100,000 per QALY, compared with oral bisphosphonate therapy only. This analysis will help clinicians and policymakers make better decisions about treatment options to reduce fracture risk.

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Correspondence to T. Mori.

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Conflict of Interest

The authors (Takahiro Mori, Carolyn J. Crandall, and David A. Ganz) declare that they have no conflict of interest. Takahiro Mori was supported by the Veterans Affairs Special Fellowship in Advanced Geriatrics. The Department of Veterans Affairs had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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Supplemental Figure 1

a Results of Deterministic Sensitivity Analyses, Age 65 (PNG 105 kb)

b. Results of Deterministic Sensitivity Analyses, Age 70 (PNG 101 kb)

c Results of Deterministic Sensitivity Analyses, Age 75 (PNG 102 kb)

198_2016_3772_MOESM6_ESM.png

d Results of Deterministic Sensitivity Analyses, Age 80 (PNG 101 kb)

The figures present the incremental cost-effectiveness ratios of the combined strategy compared with bisphosphonates alone, when varying the indicated model parameters across their ranges. The vertical hashed line represents $100,000 per QALY. Please refer to Table 1 for the ranges of each parameter. Other osteoporotic fractures included humerus, distal forearm other than wrist, pelvis, tibia/fibula, or femur other than hip

Supplemental Figure 2

a Results of Probabilistic Sensitivity Analyses, Age 65 (PNG 109 kb)

b Results of Probabilistic Sensitivity Analyses, Age 70 (PNG 111 kb)

c Results of Probabilistic Sensitivity Analyses, Age 75 (PNG 112 kb)

d Results of Probabilistic Sensitivity Analyses, Age 80 (PNG 111 kb)

The cost-effectiveness acceptability curves represent probabilities of being cost-effective compared with the next best alternative at different levels of willingness-to-pay per QALY gained

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Mori, T., Crandall, C.J. & Ganz, D.A. Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA. Osteoporos Int 28, 585–595 (2017). https://doi.org/10.1007/s00198-016-3772-7

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Keywords

  • Cost-effectiveness analysis
  • Falls prevention exercise
  • Fracture prevention
  • Oral bisphosphonate therapy
  • Osteoporosis