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Cost-effectiveness results for the treatment of osteoporosis, hypertension and hyperlipidaemia for women in different risk groups based on a societal perspective (cost (US$) per gained quality adjusted life year)*
Source publication
This paper assessed the cost-effectiveness of the treatment of high risk women with osteoporosis, hypertension and hyperlipidaemia in Sweden, using one model and a societal perspective. Cost-effective scenarios were found in all these chronic disorders. These findings are of relevance for decisions on the efficient allocation of health care resourc...
Contexts in source publication
Context 1
... cost per gained QALY for the different high risk female populations is presented with (Table 4) and without (Table 5) costs in added years of life. A 5-year treatment of osteoporosis, compared with no therapy was cost- effective in all populations, except for 50-year-old women, since the average fracture risks are relatively low in this age group (Table 4). ...
Context 2
... cost per gained QALY for the different high risk female populations is presented with (Table 4) and without (Table 5) costs in added years of life. A 5-year treatment of osteoporosis, compared with no therapy was cost- effective in all populations, except for 50-year-old women, since the average fracture risks are relatively low in this age group (Table 4). The CE results for the treatment of osteoporosis varied between cost-savings to US$ 97,000 per gained QALY. ...
Context 3
... stochastic analysis was performed for three base- case populations (see figures in bold in Table 4) and are presented as CEA curves in Fig. 1. Given that willingness to pay exceeds 50,000 US$, the results indicate that all the treatments were markedly cost-effective. ...
Context 4
... Hydrochlorothiazide Alendronate Fig. 1 The proportion of simulations defined as cost effective at different willingness to pay for three base-case populations and treatments (defined by the cost-effectiveness figures in bold in Table 4) of osteoporosis, hypertension and hyperlipidaemia. Model- ling, which is a way of integrating the best available data on health effects, risks and costs, is necessary because clinical trials cannot provide all the information that is required for an assessment of the CE in clinical practice. ...
Citations
... We found that significantly more women with DM had osteoporosis than women with no DM; this is comparable to the findings of other studies in which DM correlated significantly with osteoporosis [15,34]. ...
... More recently, similar analyses have been conducted for denosumab [82,83,84]. In addition to assessing these treatment modalities for osteoporosis, it was possible to compare costeffectiveness with interventions in other chronic non-communicable diseases such as hypertension and hyperlipidaemia [85]. ...
This paper reviews the research programme that went into the development of FRAX® and its impact in the 10 years since its release in 2008.
Introduction
Osteoporosis is defined on the measurement of bone mineral density though the clinical consequence is fracture. The sensitivity of bone mineral density measurements for fracture prediction is low, leading to the development of FRAX to better calculate the likelihood of fracture and target anti-osteoporosis treatments.
Methods
The method used in this paper is literature review.
Results
FRAX, developed over an 8-year period, was launched in 2008. Since the launch of FRAX, models have been made available for 64 countries and in 31 languages covering more than 80% of the world population.
Conclusion
FRAX provides an advance in fracture risk assessment and a reference technology platform for future improvements in performance characteristics.
... We found that significantly more women with DM had osteoporosis than women with no DM; this is comparable to the findings of other studies in which DM correlated significantly with osteoporosis [15,34]. ...
This cross-sectional study was carried out to examine the association between osteoporosis and specific risk factors among 384 women referred to the Radiology Department at King Abdullah University Hospital, Irbid, Jordan during the period September 2009-August 2010 for diagnosis of osteopenia or osteoporosis. Bone mineral density measurements were carried out using dual energy X-ray absorptiometry at both the lumbar spine [AP: L1-L4] and femoral hip [neck, trochanter]. Studied risk factors included age, age at menarche, menopause, body mass index, diabetes mellitus, hypertension, renal problems and smoking. The prevalence of osteoporosis among the studied sample was 13.5%. Osteoporosis was significantly associated with current age, age at menarche, diabetes mellitus, hypertension, and renal problems
... We found that significantly more women with DM had osteoporosis than women with no DM; this is comparable to the findings of other studies in which DM correlated significantly with osteoporosis [15,34]. ...
This cross-sectional study was carried out to examine the association between osteoporosis and specific risk factors among 384 women referred to the Radiology Department at King Abdullah University Hospital, Irbid, Jordan during the period September 2009–August 2010 for diagnosis of osteopenia or osteoporosis. Bone mineral density measurements were carried out using dual energy X-ray absorptiometry at both the lumbar spine [AP: L1–L4] and femoral hip (neck, trochanter). Studied risk factors included age, age at menarche, menopause, body mass index, diabetes mellitus, hypertension, renal problems and smoking. The prevalence of osteoporosis among the studied sample was 13.5%. Osteoporosis was significantly associated with current age, age at menarche, diabetes mellitus, hypertension, and renal problems.
... Keywords Osteoporosis Á Percutaneous vertebroplasty Á Vertebral fractures Á Prophylactic augmentation Introduction A painful vertebral fracture can be a significant burden for patients, limiting physical function and quality of life (QoL), and increasing social isolation [1,2]. The fractures may cause depression and can result in decreased mobility, loss of independence and increased mortality because of a reduction in lung capacity and abdominal space with a consequent loss of appetite [3,4]. ...
Vertebroplasty (VP) is a cost-efficient alternative to kyphoplasty; however, regarding safety and vertebral body (VB) height restoration, it is considered inferior. We assessed the safety and efficacy of VP in alleviating pain, improving quality of life (QoL) and restoring alignment.
In a prospective monocenter case series from May 2007 until July 2008, there were 1,408 vertebroplasties performed during 319 interventions in 306 patients with traumatic, lytic and osteoporotic fractures. The 249 interventions in 233 patients performed because of osteoporotic vertebral fractures were analyzed regarding demographics, treatment and radiographic details, pain alleviation (VAS), QoL improvement (NASS and EQ-5D), complications and predictors for new fractures requiring a reoperation.
The osteoporotic patient sample consisted of 76.7% (179) females with a median age of 80 years. A total of 54 males had a median age of 77 years. On average, there were 1.8 VBs fractured and 5 VBs treated. The preoperative pain was assessed by the visual analog scale (VAS) and decreased from 54.9 to 40.4 pts after 2 months and 31.2 pts after 6 months. Accordingly, the QoL on the EQ-5D measure (-0.6 to 1) improved from 0.35 pts before surgery to 0.56 pts after 2 and to 0.68 pts after 6 months. The preoperative Beck Index (anterior height/posterior height) improved from a mean of 0.64 preoperative to 0.76 postoperative, remained stable at 2 months and slightly deteriorated to 0.72 at 6 months postoperatively. There were cement leakages in 26% of the fractured VBs and in 1.4% of the prophylactically cemented VBs; there were symptoms in 4.3%, and most of them were temporary hypotension and one pulmonary cement embolism that remained asymptomatic. The univariate regression model revealed a tendency for a reduced risk for new or refractures on radiographs (OR = 2.61, 95% CI 0.92-7.38, p = 0.12) and reoperations (OR = 2.9, 95% CI 0.94-8.949, p = 0.1) when prophylactic augmentation was performed. The final multivariate regression model revealed male patients to have an about three times higher refracture risk (radiographic) (OR = 2.78, p = 0.02) at 6 months after surgery. Patients with a lumbar index fracture had an about three to five times higher refracture/reoperation risk than patients with a thoracic (OR = 0.33/0.35, p = 0.009/0.01) or thoracolumbar (OR = 0.32/0.22, p = 0.099/0.01) index fracture.
If routinely used, VP is a safe and efficacious treatment option for osteoporotic vertebral fractures with regard to pain relief and improvement of the QoL. Even segmental realignment can be partially achieved with proper patient positioning. Certain patient or fracture characteristics increase the risk for early radiographic refractures or new fractures, or a reoperation; a consequent prophylactic augmentation showed protective tendencies, but the study was underpowered for a final conclusion.
... [108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123][124][125] Few of these studies included genderstratified or gender-specific analyses 119,122 ; however, some cost-effectiveness analyses with Markov or simulation modeling presented gender-specific or women-only data. [126][127][128][129][130][131][132][133][134][135][136][137][138] Often the cost inputs and methodologies were insufficiently described or used resource consumption as a surrogate for cost. On the basis of these analyses, aspirin appears costeffective in women ≥65 years of age with moderate to severe CVD risk. ...
... [133][134][135] Antihypertensive treatments and smoking cessation treatments appear cost-effective for women. [126][127][128][129][130][131][132] Weight management approaches, including drug therapy and gastric bypass surgery, appear effective for weight loss but add costs, with decision analytic approaches noting favorable cost-effective ratios in younger and middle-aged obese women. 123,137,138 The expert panel emphasized the need for more cost-effective analyses according to gender. ...
... The osteoporosis community recognises the need to use healthcare resources effectively—and only asks that osteoporosis receives an appraisal that is equitable compared with other chronic diseases. The evidence suggests that osteoporosis can compete both in terms of the burden of disease and health economics [126, 127]. Just as a prior fracture is a strong risk factor for a further fracture, is the failure of NICE to serve osteoporosis over very many years a sign that it will continue to do so? ...
SummaryThe National Institute for Health and Clinical Excellence (NICE) in the UK issued guidance based on a health economic assessment
of interventions for the primary and secondary prevention of osteoporosis. The recommendations in the guidance are unworkable
in clinical practice and the foundation on which they are based is insecure.
IntroductionThe NICE in the UK recently issued final appraisal documents on the health economic assessment of interventions for the primary
and secondary prevention of osteoporotic fractures in postmenopausal women. The majority of interventions were considered
to be cost-ineffective except at very low T scores for bone mineral density (BMD). Concerns have been raised with respect to the construct and assumptions that populate
the model used by NICE and the feasibility of implementing the subsequent guidance.
ResultsThe application of the NICE guidance to primary care is problematic. Intervention thresholds are based on a complex array
that includes the agent to be used, age, T scores and the presence of different categories of risk factors. Alendronate is the first-line treatment, but women who cannot
take or tolerate alendronate may have to wait till their T score deteriorates before they qualify for treatment. The guidance takes no account of women with a T score > −2.5 SD, of glucocorticoid-induced disease or of men. Newer interventions, such as ibandronate and zoledronic acid,
are not included. The development of guidelines by the National Osteoporosis Guideline Group (NOGG) avoids many of these problems
and unlike the NICE guidance, can be used with FRAX®, the WHO-supported fracture risk assessment tool. NOGG provides intervention
thresholds based on fracture probabilities computed from clinical risk factors for fracture with or without information on
BMD that are readily accessed by primary care physicians for the assessment of all postmenopausal women and men over the age
of 50years. The NICE guidance is based on a health economic assessment of several interventions. The model used to assess
cost-effectiveness is based on Gaussian regression functions which were derived from an individual state transition model.
Since the source individual state transition model is not available, the Gaussian functions cannot be evaluated. Moreover,
neither the internal nor external validity of the model is established, and the model is not accessible for such an evaluation.
Although the NICE model incorporates the clinical risk factors (CRFs) used in FRAX, it neglects the impact of CRFs on the
death hazards giving estimates of fracture probability that differ from those using FRAX®. The estimates of cost-effectiveness
differ from reference models for reasons that relate in part to the model construct and in particular to the assumptions used
to populate the model.
ConclusionsThe guidance provided by NICE is cumbersome and cannot be readily used in the setting of primary care. The model on which
the guidance is based is opaque. The authors do not support the view of NICE that there are no issues which cause it to doubt
the validity of the model or that raise justifiable doubts about the appropriateness of the use of the model to inform its
guidance.
KeywordsFRAX–Economic models–Fracture probability–Clinical risk factors–Intervention thresholds
... Ideally, a common modelling framework should be adopted to compare the cost-effectiveness of different interventions within and between disease areas. The cost-effectiveness has been estimated for a female population aged 50–80 years with osteoporosis, hyperlipidaemia and hypertension alone or in combination with risk factors such as diabetes and smoking using the same model construct set in Sweden [166]. Patient groups were defined by age and risk profile. ...
... At each age, four differentTable 22 Cost-effectiveness (Euro per QALY gained) for the treatment of osteoporosis, hypertension and hyperlipidaemia for women in different risk groups based on a societal perspective. (Adapted from [166]) levels of risk were chosen for each disease. For the osteoporosis group, patients were defined according to the T-score for BMD (T-score −2.5 and −3.0 SD) with or without a history of a previous fragility fracture. ...
Guidance is provided in a European setting on the assessment and treatment of postmenopausal women with or at risk from osteoporosis.
The European Foundation for Osteoporosis and Bone disease (subsequently the International Osteoporosis Foundation) published guidelines for the diagnosis and management of osteoporosis in 1997. This manuscript updates these in a European setting.
The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case finding strategies; investigation of patients; health economics of treatment.
A platform is provided on which specific guidelines can be developed for national use.
Osteoporotic fractures, in particular hip and vertebral, are a major health burden worldwide. The majority of these fractures occur in the elderly population, resulting in one of the most important causes of mortality and disability in older ages. Their cost for societies is enormous and is forecast to steadily increase over the coming decades globally. Low bone mineral density (BMD) remains a key preventable risk factor for fractures. Screening and treatment of individuals with high risk of fracture is cost-effective. Predictive tools including clinical risk factors, minimisation of falls risk and public authorities' support to create Fracture Liaison Services are paramount strategies.
