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Cost-effective osteoporosis treatment thresholds: the United States perspective

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Abstract

Summary

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.

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Acknowledgements

The authors thank Dr. John Kanis for his insightful advice regarding this analysis. We also thank David Radley and Margaret Grove for their assistance with model development and analyses.

Conflicts of interest

None.

Funding

This study was supported by the National Osteoporosis Foundation. It was also supported in part by grants from the National Institutes of Health (AR048094 and AG12262).

Author information

Authors and Affiliations

  1. Multidisciplinary Clinical Research Center in Musculoskeletal Diseases and The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH, USA

    A. N. A. Tosteson

  2. Division of Epidemiology, College of Medicine, Mayo Clinic, Rochester, MN, USA

    L. J. Melton III

  3. Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA

    B. Dawson-Hughes

  4. The Medical College of Wisconsin, Milwaukee, WI, USA

    S. Baim

  5. Department of Medicine, University of Chicago, Chicago, IL, USA

    M. J. Favus

  6. Division of Endocrinology, College of Medicine, Mayo Clinic, Rochester, MN, USA

    S. Khosla

  7. Helen Hayes Hospital, Regional Bone Center, West Haverstraw, NY, USA

    R. L. Lindsay

  8. HB7505 Clinical Research, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH, 03756, USA

    A. N. A. Tosteson

Authors
  1. A. N. A. Tosteson
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  2. L. J. Melton III
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  3. B. Dawson-Hughes
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  4. S. Baim
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  5. M. J. Favus
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  6. S. Khosla
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  7. R. L. Lindsay
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Corresponding author

Correspondence to A. N. A. Tosteson.

Additional information

The authors comprise the National Osteoporosis Foundation Guide Committee.

Appendix

Appendix

Table 3 Age-specific annual fracture probability by fracture type and gender for the white population*
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Tosteson, A.N.A., Melton, L.J., Dawson-Hughes, B. et al. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int 19, 437–447 (2008). https://doi.org/10.1007/s00198-007-0550-6

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  • DOI: https://doi.org/10.1007/s00198-007-0550-6

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