A Systematic Review of Cost-Effectiveness Analyses of Drugs for Postmenopausal Osteoporosis

Hiligsmann, Mickaël; Evers, Silvia M. A. A.; Sedrine, Wafa Ben; Kanis, John А.; Ramaekers, Bram; Reginster, Jean‐Yves; Silverman, Stuart L.; Wyers, Caroline E.; Boonen, Annelies

doi:10.1007/s40273-014-0231-1

Cited by 85 publications

(74 citation statements)

References 68 publications

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“…Our analysis also only considered the effect of a hip fracture service on the immediate perioperative period, and did not account for the future downstream benefit of increased initiation of osteoporosis treatment, which has been shown to be better in a comanagement model [22,28] and also to be net cost effective [31,32,35], but this is a much more remote benefit. Additionally, although a few studies have reported improved readmission rates with comanagement [5,39], others have reported no change [17,24,28,52].…”

Section: Discussionmentioning

confidence: 99%

“…Highquality economic studies have evaluated the benefits of directing resources toward the focused goal of reducing time to the operating room [19] and the benefits of early initiation of osteoporosis treatment [31,32,35]. Additionally, numerous studies have identified important predictors of perioperative complications, costs, and mortality [5,13,18,41,46,49,53,54,65], suggesting that different patient populations may have different predisposing risk factors, and thus experience different degrees of benefit from a comanagement system.…”

Section: Introductionmentioning

confidence: 99%

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Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Swart

Vasudeva

Makhni

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Osteoporotic hip fractures are common injuries typically occurring in patients who are older and medically frail. Studies have suggested that creation of a multidisciplinary team including orthopaedic surgeons, internal medicine physicians, social workers, and specialized physical therapists, to comanage these patients can decrease complication rates, improve time to surgery, and reduce hospital length of stay; however, they have yet to achieve widespread implementation, partly owing to concerns regarding resource requirements necessary for a comanagement program. Questions/Purposes We performed an economic analysis to determine whether implementation of a comanagement model of care for geriatric patients with osteoporotic hip fractures would be a cost-effective intervention at hospitals with moderate volume. We also calculated what annual volume of cases would be needed for a comanagement program to ''break even'', and finally we evaluated whether universal or risk-stratified comanagement was more cost effective. Methods Decision analysis techniques were used to model the effect of implementing a systems-based strategy to improve inpatient perioperative care. Costs were obtained from best-available literature and included salary to support personnel and resources to expedite time to the operating room. The major economic benefit was decreased initial hospital length of stay, which was determined via literature review and meta-analysis, and a health benefit was improvement in perioperative mortality owing to expedited preoperative evaluation based on previously conducted meta-analyses. A break-even analysis was conducted to determine the annual case volume necessary for comanagement to be either (1) cost effective (improve health-related quality of life enough to be worth additional expenses) or (2) result in cost savings (actually result in decreased total expenses). This calculation assumed the scenario in which a hospital could hire only one hospitalist (and therapist and social worker) on a full-time basis. Additionally, we evaluated the scenario where the necessary staff was already employed at the hospital and could be dedicated to a comanagement service on a part-time basis, and explored the effect of triaging only patients considered high risk to a comanagement service versus comanaging all geriatric patients. Finally, probabilistic sensitivity analysis was conducted on all critical variables, with broad ranges used for values around which there was higher uncertainty. Results For the base case, universal comanagement was more cost effective than traditional care and risk-stratified comanagement (incremental cost effectiveness ratios of All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Swart

Vasudeva

Makhni

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Relative risk reductions of spine and non-vertebral fractures by TABM in subjects with bone densitometry diagnosed osteoporosis are 40-60% and 20-40%, respectively (14,61). Number-Needed-to-Treat (NNT) to prevent a fracture is lower in people at high risk of fractures, and especially in those with prior fragility fractures (13,37,(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73).…”

Section: Primary and Secondary Prevention Related To Bone Healthmentioning

confidence: 99%

A comprehensive fracture prevention strategy in older adults: The European union geriatric medicine society (EUGMS) statement

Blain¹,

Masud

Dargent-Molina

et al. 2016

European Geriatric Medicine

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“…In the field of osteoporosis, the number of economic evaluations has increased markedly in recent years [3, 4]. Economic evaluations have been conducted to assess the cost-effectiveness of anti-osteoporotic drugs [3, 5, 6], to identify cost-effective intervention thresholds for fracture risk [7–9], and to estimate the cost-effectiveness of osteoporosis programs for screening patients [10, 11] or fracture liaison services for secondary fracture prevention [12].…”

Section: Introductionmentioning

confidence: 99%

Recommendations for the conduct of economic evaluations in osteoporosis: outcomes of an experts’ consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the US branch of the International Osteoporosis Foundation

et al. 2018

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SummaryEconomic evaluations are increasingly used to assess the value of health interventions, but variable quality and heterogeneity limit the use of these evaluations by decision-makers. These recommendations provide guidance for the design, conduct, and reporting of economic evaluations in osteoporosis to improve their transparency, comparability, and methodologic standards.IntroductionThis paper aims to provide recommendations for the conduct of economic evaluations in osteoporosis in order to improve their transparency, comparability, and methodologic standards.MethodsA working group was convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis to make recommendations for the design, conduct, and reporting of economic evaluations in osteoporosis, to define an osteoporosis-specific reference case to serve a minimum standard for all economic analyses in osteoporosis, to discuss methodologic challenges and initiate a call for research. A literature review, a face-to-face meeting in New York City (including 11 experts), and a review/approval by a larger group of experts worldwide (including 23 experts in total) were conducted.ResultsRecommendations on the type of economic evaluation, methods for economic evaluation, modeling aspects, base-case analysis and population, excess mortality, fracture costs and disutility, treatment characteristics, and model validation were provided. Recommendations for reporting economic evaluations in osteoporosis were also made and an osteoporosis-specific checklist was designed that includes items to report when performing an economic evaluation in osteoporosis. Further, 12 minimum criteria for economic evaluations in osteoporosis were identified and 12 methodologic challenges and need for further research were discussed.ConclusionWhile the working group acknowledges challenges and the need for further research, these recommendations are intended to supplement general and national guidelines for economic evaluations, improve transparency, quality, and comparability of economic evaluations in osteoporosis, and maintain methodologic standards to increase their use by decision-makers.

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A Systematic Review of Cost-Effectiveness Analyses of Drugs for Postmenopausal Osteoporosis

Cited by 85 publications

References 68 publications

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

A comprehensive fracture prevention strategy in older adults: The European union geriatric medicine society (EUGMS) statement

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