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.
Similar content being viewed by others
References
Majumdar SR (2011) A T-2 translational research perspective on interventions to improve post-fracture osteoporosis care. Osteoporos Int 22(Suppl 3):471–476
Lyritis GP, Rizou S, Galanos A, Makras P (2013) Incidence of hip fractures in Greece during a 30-year period: 1977-2007. Osteoporos Int 24:1579–1585
Svedbom A, Hernlund E, Ivergard M et al (2013) Epidemiology and economic burden of osteoporosis in Greece. Arch Osteoporos 8:83–90
Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA 286:2815–2822
Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A (2000) Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 27:585–590
Makras P, Vaiopoulos G, Lyritis GP, Greek National Medicine A (2012) 2011 guidelines for the diagnosis and treatment of osteoporosis in Greece. J Musculoskelet Neuronal Interact 12:38–42
Compston J, Cooper A, Cooper C et al (2009) Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas 62:105–108
Badurski JE, Kanis JA, Johansson H, Dobrenko A, Nowak NA, Daniluk S, Jezienicka E (2011) The application of FRAX(R) to determine intervention thresholds in osteoporosis treatment in Poland. Pol Arch Med Wewn 121:148–155
Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, Baim S, Favus MJ, Khosla S, Lindsay RL, National Osteoporosis Foundation Guide C (2008) Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int 19:437–447
Fujiwara S (2008) Daily practice using guidelines for prevention and treatment of osteoporosis. Risk factors for fracture and guideline for prevention of fracture. Clin Calcium 18:1079–1083
Grossman JM, Gordon R, Ranganath VK et al (2010) American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken) 62:1515–1526
Lippuner K, Johansson H, Kanis JA, Rizzoli R (2010) FRAX assessment of osteoporotic fracture probability in Switzerland. Osteoporos Int 21:381–389
Papaioannou A, Morin S, Cheung AM et al (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873
Dawson-Hughes B, National Osteoporosis Foundation Guide C (2008) A revised clinician’s guide to the prevention and treatment of osteoporosis. J Clin Endocrinol Metab 93:2463–2465
Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A, National Osteoporosis Guideline G (2008) Case finding for the management of osteoporosis with FRAX—assessment and intervention thresholds for the UK. Osteoporos Int 19:1395–1408
Lippuner K, Johansson H, Borgstrom F, Kanis JA, Rizzoli R (2012) Cost-effective intervention thresholds against osteoporotic fractures based on FRAX(R) in Switzerland. Osteoporos Int 23:2579–2589
National Osteoporosis Foundation (NOF) (2010) The clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation. www.nof.org, Washington, DC
Zethraeus N, Borgstrom F, Strom O, Kanis JA, Jonsson B (2007) Cost-effectiveness of the treatment and prevention of osteoporosis—a review of the literature and a reference model. Osteoporos Int 18:9–23
WHO Fracture Risk Assessment Tool. http://www.shef.ac.uk/FRAX/?lang=en (Accessed 20th June 2014)
Eddy DM, Hollingworth W, Caro JJ, Tsevat J, McDonald KM, Wong JB, Force I-SMGRPT (2012) Model transparency and validation: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force—7. Value Health 15:843–850
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475
Poor G, Atkinson EJ, O’Fallon WM, Melton LJ, 3rd (1995) Determinants of reduced survival following hip fractures in men. Clin Orthop Relat Res 319:260–265
Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112
Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136
National Organization For Health Care Services Provision (NOHCSP). http://www.eopyy.gov.gr/Home/StartPage?a_HomePage=Index (site in Greek). (Accessed 30th March 2014)
Hellenic Association of Pharmaceutical Companies (HAPC). http://www.sfee.gr/en/medicine-prices (Accessed 3rd April 2014)
National Organization For Health Care Services Provision (NOHCSP). Availableat http://www.eof.gr/web/guest/home; (site in Greek) (Accessed 15th May 2014)
European Commission Economic and Financial Affairs. Available at http://ec.europa.eu/economy_finance/ameco/user/serie/ResultSerie.cfm (Accessed 4th October 2014)
Strom O, Borgstrom F, Kleman M, McCloskey E, Oden A, Johansson H, Kanis JA (2010) FRAX and its applications in health economics—cost-effectiveness and intervention thresholds using bazedoxifene in a Swedish setting as an example. Bone 47:430–437
Strom O, Jonsson B, Kanis JA (2013) Intervention thresholds for denosumab in the UK using a FRAX(R)-based cost-effectiveness analysis. Osteoporos Int 24:1491–1502
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
Polyzois Makras and Konstantinos Athanasakis contributed equally to this paper.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-015-3055-8