ARS | Publication request: Cost-Effectiveness Osteoporosis Treatment Thresholds: The United States Perspective from the National Osteoporosis Foundation Guide Committee

Submitted to: Osteoporosis International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: December 20, 2007
Publication Date: February 21, 2008
Citation: Tosteson, A., Melton, L.J., Dawson-Hughes, B., Baim, S., Favus, M.J., Khosla, S., Lindsay, R. 2008. Cost-Effectiveness Osteoporosis Treatment Thresholds: The United States Perspective from the National Osteoporosis Foundation Guide Committee. Osteoporosis International. DOI 10.1007/s00198-007-0550-6

Interpretive Summary: Rapid growth of the elderly U.S. population will result in so many at risk for osteoporosis that cost-effective approaches to prevention and treatment are warranted. This analysis applies an economic model to the World Health Organization risk prediction to determine the level of risk for osteoporosis that warrants treatment to prevent fractures. The model considers the fracture rates, life style and other risk factors, and the health care costs of treating fractures of the hip, spine, and forearm in men and women in the United States. The 10-year hip fracture risk at which treatment is cost-effective in the United States is approximately 3%. This figure is relatively constant across gender and race/ethnic groups. The findings from this analysis will be used to update the National Osteoporosis Foundation clinical practice guidelines for the prevention and treatment of osteoporosis.

Technical Abstract: 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 hip, wrist, clinical spine and other 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.