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

  • Kanis J
  • Johnell O
  • Oden A
 et al. 
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Abstract

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.

Author-supplied keywords

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

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Authors

  • John a Kanis

  • Olof Johnell

  • Anders Oden

  • Frederik Borgstrom

  • Helena Johansson

  • Chris De Laet

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