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At what hip fracture risk is it cost-effective to treat? International intervention thresholds for the treatment of osteoporosis

Borgström, F. ; Johnell, Olof LU ; Kanis, J. A. ; Joensson, B. and Rehnberg, C. (2006) In Osteoporosis International 17(10). p.1459-1471
Abstract
Introduction: Intervention thresholds (ITs), the 10-year hip fracture risk at which treatment can be considered to be cost-effective, have previously been estimated for Sweden and the UK. Objective: The aim of this study was to provide a Markov cohort model platform for a multinational estimation of thresholds at which intervention becomes cost-effective and to investigate and determine the main factors behind differences in these thresholds between countries. Results and discussion: Intervention thresholds were estimated for Australia, Germany, Japan, Sweden, Spain, the UK and USA using a societal perspective. The model was populated with as much relevant country-specific data as possible. Intervention was assumed to be given for 5 years... (More)
Introduction: Intervention thresholds (ITs), the 10-year hip fracture risk at which treatment can be considered to be cost-effective, have previously been estimated for Sweden and the UK. Objective: The aim of this study was to provide a Markov cohort model platform for a multinational estimation of thresholds at which intervention becomes cost-effective and to investigate and determine the main factors behind differences in these thresholds between countries. Results and discussion: Intervention thresholds were estimated for Australia, Germany, Japan, Sweden, Spain, the UK and USA using a societal perspective. The model was populated with as much relevant country-specific data as possible. Intervention was assumed to be given for 5 years and to decrease the risk of all osteoporotic fractures by 35%. The societal willingness to pay (WTP) for a quality-adjusted life-year (QALY) gained was set to the gross domestic product (GDP) per capita multiplied by two. In the base case analysis, the 10-year hip fracture probability at which intervention became cost-effective varied across ages and countries. For women starting therapy at an age of 70 years, the IT varied from a hip fracture probability of 5.6% in Japan to 14.7% in Spain. The main factors explaining differences in the IT between countries were the WTP for a QALY gained, fracture-related costs and intervention costs. Conclusion: The ITs presented in this paper are appropriate for use in treatment guidelines that consider health economic aspects, and they can be used in combination with fracture risk prediction algorithms to improve the selection of patients who are suitable for osteoporotic intervention. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
osteoporosis, intervention threshold, cost-effectiveness, hip fracture
in
Osteoporosis International
volume
17
issue
10
pages
1459 - 1471
publisher
Springer
external identifiers
  • wos:000240531900003
  • scopus:33748635801
ISSN
1433-2965
DOI
10.1007/s00198-006-0107-0
language
English
LU publication?
yes
id
b0c847d0-35ce-42e5-b971-b1aad3cc30ee (old id 686155)
date added to LUP
2016-04-01 15:31:54
date last changed
2020-03-24 04:26:12
@article{b0c847d0-35ce-42e5-b971-b1aad3cc30ee,
  abstract     = {Introduction: Intervention thresholds (ITs), the 10-year hip fracture risk at which treatment can be considered to be cost-effective, have previously been estimated for Sweden and the UK. Objective: The aim of this study was to provide a Markov cohort model platform for a multinational estimation of thresholds at which intervention becomes cost-effective and to investigate and determine the main factors behind differences in these thresholds between countries. Results and discussion: Intervention thresholds were estimated for Australia, Germany, Japan, Sweden, Spain, the UK and USA using a societal perspective. The model was populated with as much relevant country-specific data as possible. Intervention was assumed to be given for 5 years and to decrease the risk of all osteoporotic fractures by 35%. The societal willingness to pay (WTP) for a quality-adjusted life-year (QALY) gained was set to the gross domestic product (GDP) per capita multiplied by two. In the base case analysis, the 10-year hip fracture probability at which intervention became cost-effective varied across ages and countries. For women starting therapy at an age of 70 years, the IT varied from a hip fracture probability of 5.6% in Japan to 14.7% in Spain. The main factors explaining differences in the IT between countries were the WTP for a QALY gained, fracture-related costs and intervention costs. Conclusion: The ITs presented in this paper are appropriate for use in treatment guidelines that consider health economic aspects, and they can be used in combination with fracture risk prediction algorithms to improve the selection of patients who are suitable for osteoporotic intervention.},
  author       = {Borgström, F. and Johnell, Olof and Kanis, J. A. and Joensson, B. and Rehnberg, C.},
  issn         = {1433-2965},
  language     = {eng},
  number       = {10},
  pages        = {1459--1471},
  publisher    = {Springer},
  series       = {Osteoporosis International},
  title        = {At what hip fracture risk is it cost-effective to treat? International intervention thresholds for the treatment of osteoporosis},
  url          = {http://dx.doi.org/10.1007/s00198-006-0107-0},
  doi          = {10.1007/s00198-006-0107-0},
  volume       = {17},
  year         = {2006},
}