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Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden.

John A Kanis ; Olof Johnell ; Anders Odén (Institutionen för matematiska vetenskaper, matematisk statistik) ; Frederik Borgstrom ; Helena Johansson ; Chris De Laet ; Bengt Jönsson
Osteoporosis international (0937-941X). Vol. 16 (2005), 1, p. 6-14.
[Artikel, refereegranskad vetenskaplig]

The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in men and women, based on data from Sweden. We modeled the effects of a treatment costing $500 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35% followed by a waning of effect for a further 5 years. Sensitivity analyses included a range of effectiveness (10-50%) and a range of intervention costs ($200-500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of approximately $45,000/QALY gained was used. Cost of added years was included in a sensitivity analysis. With the base case ($500 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for cost-effectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted cost-effectively to individuals at moderately increased fracture risk.

Nyckelord: Age Factors, Aged, Aged, 80 and over, Cost-Benefit Analysis, methods, Female, Fractures, Bone, economics, epidemiology, prevention & control, Hip Fractures, prevention & control, Humans, Male, Markov Chains, Middle Aged, Osteoporosis, drug therapy, economics, epidemiology, Risk Factors, Sex Factors, Sweden, epidemiology

Denna post skapades 2010-01-09. Senast ändrad 2010-01-26.
CPL Pubid: 106061


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Institutionen för matematiska vetenskaper, matematisk statistik (2005-2016)
Institutionen för samhällsmedicin, Avdelningen för geriatrik (1900-2005)


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