An economic evaluation: Simulation of the cost-effectiveness and cost-utility of universal prevention strategies against osteoporosis-related fractures

Abstract

A patient-level Markov decision model was used to simulate a virtual cohort of 500,000 women 40 years old and over, in relation to osteoporosis-related hip, clinical vertebral, and wrist bone fractures events. Sixteen different screening options of three main scenario groups were compared: (1) the status quo (no specific national prevention program); (2) a universal primary prevention program; and (3) a universal screening and treatment program based on the 10-year absolute risk of fracture. The outcomes measured were total directs costs from the perspective of the public health care system, number of fractures, and quality-adjusted life-years (QALYs). Results show that an option consisting of a program promoting physical activity and treatment if a fracture occurs is the most cost-effective (CE) (cost/fracture averted) alternative and also the only cost saving one, especially for women 40 to 64 years old. In women who are 65 years and over, bone mineral density (BMD)-based screening and treatment based on the 10-year absolute fracture risk calculated using a Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool is the best next alternative. In terms of cost-utility (CU), results were similar. For women less than 65 years old, a program promoting physical activity emerged as cost-saving but BMD-based screening with pharmacological treatment also emerged as an interesting alternative. In conclusion, a program promoting physical activity is the most CE and CU option for women 40 to 64 years old. BMD screening and pharmacological treatment might be considered a reasonable alternative for women 65 years old and over because at a healthcare capacity of $50,000 Canadian dollars ($CAD) for each additional fracture averted or for one QALY gained its probabilities of cost-effectiveness compared to the program promoting physical activity are 63% and 75%, respectively, which could be considered socially acceptable. Consideration of the indirect costs could change these findings.

Osteoporosis Associated with Antipsychotic Treatment in Schizophrenia

“…Osteoporosis is characterized by decreased bone stiffness, as signified by low bone mineral density (BMD), vertebral or nonvertebral fragility fractures, and disruption of bone microarchitecture. It is a significant health problem afflicting the global people [5, 6], and the female cases were more than male ones (5:2) older than 50 years of age, which brings about a disease burden of around £ 1.8 billion in the UK and £ 30 billion in whole Europe [7]. Although the high incidence rate of osteoporosis and osteoporotic fractures in the schizophrenic patients was first reported about 20 years ago [8–10], related reports about the increased risk of osteoporotic fracture and earlier onset of osteoporosis in the schizophrenic patients are seldom published [11].…”

Randomized controlled trial of zoledronic acid for treatment of osteoporosis in women

“…3,4 Osteoporosis-related fractures are usually associated with increased morbidity and mortality, and increased healthcare costs. [5][6][7] Several therapies (including teriparatide, calcitonin, alendronate and strontium ranelate) have been shown to be well tolerated and effective in the prevention of osteoporosis. [8][9][10] Clinical studies have indicated that nitrogen-containing bisphosphonates not only inhibit bone resorption but also preserve bone mass, thereby reducing the risk of osteoporotic fractures.…”

Cost-Effectiveness of Intervention Thresholds for the Treatment of Osteoporosis Based on FRAX® in Portugal

“…From both the health economics and the clinical viewpoint, it is appropriate that treatment decisions on osteoporosis are based on the absolute risk of fracture as opposed to the consideration of relative risks and the impact of individual risk factors [3,[37][38][39]. Only with absolute risks of fracture and the quantified consideration of the effectiveness of interventions can the practicing clinician estimate the true value of an intervention and, thus, its indication.…”