Cost-effective osteoporosis treatment thresholds: The United States perspective

A. N.A. Tosteson, L. J. Melton, B. Dawson-Hughes, S. Baim, M. J. Favus, S. Khosla, R. L. Lindsay

Research output: Contribution to journalArticlepeer-review

334 Scopus citations

Abstract

A United States-specific cost-effectiveness analysis, which incorporated the cost and health consequences of clinical fractures of the hip, spine, forearm, shoulder, rib, pelvis and lower leg, was undertaken to identify the 10-year hip fracture probability required for osteoporosis treatment to be cost-effective for cohorts defined by age, sex, and race/ethnicity. A 3% 10-year risk of hip fracture was generally required for osteoporosis treatment to cost less than $60,000 per QALY gained. Introduction: Rapid growth of the elderly United States population will result in so many at risk of osteoporosis that economically efficient approaches to osteoporosis care warrant consideration. Methods: A Markov-cohort model of annual United States age-specific incidence of clinical hip, spine, forearm, shoulder, rib, pelvis and lower leg fractures, costs (2005 US dollars), and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment ($600/yr drug cost for 5 years with 35% fracture reduction) by gender and race/ethnicity groups. To determine the 10-year hip fracture probability at which treatment became cost-effective, average annual age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until a cost of $60,000 per QALY gained was observed for treatment relative to no intervention. Results: Osteoporosis treatment was cost-effective when the 10-year hip fracture probability reached approximately 3%. Although the RR at which treatment became cost-effective varied markedly between genders and by race/ethnicity, the absolute 10-year hip fracture probability at which intervention became cost-effective was similar across race/ethnicity groups, but tended to be slightly higher for men than for women. Conclusions: Application of the WHO risk prediction algorithm to identify individuals with a 3% 10-year hip fracture probability may facilitate efficient osteoporosis treatment.

Original languageEnglish (US)
Pages (from-to)437-447
Number of pages11
JournalOsteoporosis International
Volume19
Issue number4
DOIs
StatePublished - Apr 2008

Keywords

  • Cost-effectiveness
  • National Osteoporosis Foundation
  • Osteoporosis
  • Practice guidelines
  • World Health Organization

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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