Modelling the Cost Effectiveness of Interventions for Osteoporosis: Issues to Consider

Abstract

Expenditure on treating osteoporotic fractures and on preventative intervention is considerable and is likely to rise in forthcoming years due to the association between fracture risk and age. With funders such as the National Institute for Health and Care Excellence and the Pharmaceutical Benefits Advisory Committee explicitly considering cost effectiveness analyses within the process of producing guidance it is imperative that economic models are as robust as possible. This paper details issues that need to be considered specifically related to health technology assessments of interventions for osteoporosis and highlights limitations within the current evidence base. A likely direction of impact on cost effectiveness of addressing the key issues has been included alongside a tentative categorisation of the likely level of these impacts. It is likely that cost effectiveness ratios presented in previous models which did not address the identified issues were favourable to interventions. Declared conflict of interests: Professor Stevenson has received grants from the National Institutefor Health Research to undertake health technology assessments within the disease area of osteoporosis. The department in which Professor Selby works has received research support from Amgen who manufacture drugs for the treatment of osteoporosis but he has received no personal financial support. Key points for decision makersIn order to accurately estimate the cost effectiveness of screening policies costs of identifying people with osteoporosis but without a recent fracture must be included Rigid adherence to the definition of osteoporosis, or using a single threshold value for fracture risk over a defined period of time in deciding whether to treat or not is unlikely to be optimal approaches in terms of efficient allocation of resources A tentative categorisation of the level of impact of addressing each issue has been produced.

Cost-Effectiveness of Zoledronic Acid Versus Oral Alendronate for Postmenopausal Osteoporotic Women in China

“…Persistence and compliance during the medical treatment were considered in our research (Stevenson and Selby, 2014;Hiligsmann et al, 2015). A higher compliance rates in the clinical therapy of oral alendronate than observational studies that reflected actual real world setting.…”

Economic Evaluation of Oral Alendronate Therapy for Osteoporosis in Chinese Postmenopausal Women: The Impact of Medication Compliance and Persistence

“…Inadequate medication compliance and persistence are known to be major problems in all patients with osteoporotic disease (Stevenson and Selby, 2014). We considered compliance and persistence rates of alendronate obtained on the observational studies in the Chinese or Asian population (Cheng et al, 2013;Kishimoto and Maehara, 2015).…”

Corrigendum: A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures

“…The decision over which fractures to group together has, in previous analyses, been justified by the expectation of similar costs and disutilities across particular groups of fractures. 171 The groupings used were consistent across the three published cost-effectiveness analyses that incorporated additional sites. [141][142][143] We decided to keep the groupings used in these three studies with one exception.…”