Advanced

Intervention thresholds for osteoporosis

Kanis, JA; Johnell, Olof LU ; Oden, A; De Laet, C; Oglesby, A and Jonsson, B (2002) In Bone 31(1). p.26-31
Abstract
The aim of this study was to determine the threshold of fracture probability at which interventions become cost-effective. We modeled the effects of a treatment costing $500/year, given for 5 years, that decreased the risk of all osteoporotic fractures by 35%, followed by a waning of effect for 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 and costs in added years of life, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of $60,000 per quality-adjusted life-year (QALY) gained was used. Costs of added years were excluded in a sensitivity analysis for which a... (More)
The aim of this study was to determine the threshold of fracture probability at which interventions become cost-effective. We modeled the effects of a treatment costing $500/year, given for 5 years, that decreased the risk of all osteoporotic fractures by 35%, followed by a waning of effect for 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 and costs in added years of life, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of $60,000 per quality-adjusted life-year (QALY) gained was used. Costs of added years were excluded in a sensitivity analysis for which a threshold value of $30,000 per QALY was used. In the base case, intervention was cost-effective when treatment was targeted to women at average risk at age of greater than or equal to65 years. Irrespective of the efficacy modeled (10%-50%) or of cost of intervention ($200-500/year) segments of the population at average risk could be targeted cost-effectively: The lower the intervention cost and the higher the effectiveness, the lower the age at which intervention was cost-effective. With the base case ($500/year; 35% efficacy) treatment in women was cost-effective with a 10 year hip fracture probability that ranged from 1.4% at the age of 50 years to 4.4% at the age of 65 years. The exclusion of osteoporotic fractures other than hip fracture would increase the threshold to a 9%-11% 10 year probability because of the substantial morbidity from fractures other than hip fracture, 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 cost-effectively targeted to individuals at moderately increased risk. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
osteoporotic fracture, cost of added years, threshold, cost-effectiveness, intervention, hip fracture
in
Bone
volume
31
issue
1
pages
26 - 31
publisher
Elsevier
external identifiers
  • wos:000177036000005
  • pmid:12110408
  • scopus:0036317374
ISSN
1873-2763
DOI
10.1016/S8756-3282(02)00813-X
language
English
LU publication?
yes
id
4160b8d9-a648-4d02-b8be-8396fe63a6b9 (old id 892926)
date added to LUP
2008-01-23 11:25:32
date last changed
2017-10-29 04:09:39
@article{4160b8d9-a648-4d02-b8be-8396fe63a6b9,
  abstract     = {The aim of this study was to determine the threshold of fracture probability at which interventions become cost-effective. We modeled the effects of a treatment costing $500/year, given for 5 years, that decreased the risk of all osteoporotic fractures by 35%, followed by a waning of effect for 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 and costs in added years of life, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of $60,000 per quality-adjusted life-year (QALY) gained was used. Costs of added years were excluded in a sensitivity analysis for which a threshold value of $30,000 per QALY was used. In the base case, intervention was cost-effective when treatment was targeted to women at average risk at age of greater than or equal to65 years. Irrespective of the efficacy modeled (10%-50%) or of cost of intervention ($200-500/year) segments of the population at average risk could be targeted cost-effectively: The lower the intervention cost and the higher the effectiveness, the lower the age at which intervention was cost-effective. With the base case ($500/year; 35% efficacy) treatment in women was cost-effective with a 10 year hip fracture probability that ranged from 1.4% at the age of 50 years to 4.4% at the age of 65 years. The exclusion of osteoporotic fractures other than hip fracture would increase the threshold to a 9%-11% 10 year probability because of the substantial morbidity from fractures other than hip fracture, 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 cost-effectively targeted to individuals at moderately increased risk.},
  author       = {Kanis, JA and Johnell, Olof and Oden, A and De Laet, C and Oglesby, A and Jonsson, B},
  issn         = {1873-2763},
  keyword      = {osteoporotic fracture,cost of added years,threshold,cost-effectiveness,intervention,hip fracture},
  language     = {eng},
  number       = {1},
  pages        = {26--31},
  publisher    = {Elsevier},
  series       = {Bone},
  title        = {Intervention thresholds for osteoporosis},
  url          = {http://dx.doi.org/10.1016/S8756-3282(02)00813-X},
  volume       = {31},
  year         = {2002},
}