Authors: John A Kanis Olof Johnell Anders Oden Frederik Borgstrom Helena Johansson Chris De Laet Bengt Jönsson
Publish Date: 2004/04/22
Volume: 16, Issue: 1, Pages: 6-14
Abstract
The aim of this study was to determine the threshold of fracture probability at which interventions became costeffective 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 1050 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 costeffectiveness of approximately 45000/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 costeffective with a 10year hip fracture probability that ranged from 12 at the age of 50 years to 74 at the age of 80 years Similar results were observed in men except that the threshold for costeffectiveness was higher at younger ages than in women 20 vs 12 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 costeffectiveness 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 costeffectively to individuals at moderately increased fracture risk
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