Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden.
Journal article, 2005
The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in men and women, based on data from Sweden. We modeled the effects of a treatment costing $500 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35% followed by a waning of effect for a further 5 years. Sensitivity analyses included a range of effectiveness (10-50%) and a range of intervention costs ($200-500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of approximately $45,000/QALY gained was used. Cost of added years was included in a sensitivity analysis. With the base case ($500 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for cost-effectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted cost-effectively to individuals at moderately increased fracture risk.
Age Factors
80 and over
methods
Cost-Benefit Analysis
Aged
Aged
Humans
epidemiology
Markov Chains
Female
Bone
Fractures
economics
prevention & control
Sex Factors
epidemiology
Male
Risk Factors
Osteoporosis
Middle Aged
prevention & control
Sweden
Hip Fractures
drug therapy
epidemiology
economics
Author
John A Kanis
Olof Johnell
Anders Odén
University of Gothenburg
Chalmers, Mathematical Sciences, Mathematical Statistics
Frederik Borgstrom
Helena Johansson
University of Gothenburg
Chris De Laet
Bengt Jönsson
Osteoporosis International
0937-941X (ISSN) 1433-2965 (eISSN)
Vol. 16 1 6-14Subject Categories
Endocrinology and Diabetes
Physiology
DOI
10.1007/s00198-004-1623-4
PubMed
15103452