Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis

Abstract

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The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

“…We assumed that the relative risks for fracture following bone-protection therapy were 0.57 for vertebral fractures and 0.61 for fractures of the hip, forearm or humerus. 92 …”

“…92 These are 5.2 for vertebral fracture, 2.35 for hip fracture and 1.79 for osteoporotic fracture, which we used for fractures of the wrist/forearm and humerus. Although uncertain, the evidence and clinical opinion suggest that the excess risk of fractures disappears within 1 year of stopping steroid therapy.…”

“…These are specific to the 70-74 years age group of the general population, 92 the average age in TABUL being 71 years, and are prior to adjustment for the effect of steroids.…”

Adherence to treatment of osteoporosis: a need for study

“…Whereas poor adherence decreases the effect of intervention, this is offset to some extent by a reduction in the cost of medication. In models of persistence it has been assumed simplisticly that 20-80% of patients complete a full 5-year course of treatment, and that the remaining non-persistent patients receive 3 months of drug treatment for no health gain [38,39]. The impact on cost-effectiveness was relatively small until persistence fell below about 20%.…”

Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis

“…In previous economic studies accounting for persistence [55,56], including one commissioned by the UK National Institute for Health and Clinical Excellence [56], it was assumed that 20-80% of patients completed the full 5-year course, with the remaining patients receiving 3 months of drug costs but no health gain. A problem with such an approach is that those who discontinue treatment are likely to do so at time points throughout the 5-year period and should thus receive some health benefit, as well as additional drug costs.…”