Hostname: page-component-7c8c6479df-nwzlb Total loading time: 0 Render date: 2024-03-27T07:29:50.668Z Has data issue: false hasContentIssue false

Cost-effectiveness of fracture prevention treatments in the elderly

Published online by Cambridge University Press:  28 May 2004

Rachael L. Fleurence
Affiliation:
University of York

Abstract

Objectives: The cost-effectiveness of fracture prevention treatments (vitamin D and calcium and hip protectors) in male and female populations older than seventy years of age in the United-Kingdom was investigated.

Methods: A Markov model was developed to follow up, over lifetime, a hypothetical cohort of males and females at high-risk and general risk of fracture. Patients could sustain hip, wrist, vertebral, and/or other fractures. Fracture rates were obtained from population surveys in the United Kingdom. Effectiveness and quality of life data were identified from the clinical literature. Costs were those incurred by the UK National Health Service, and were obtained from several published sources. Uncertainty was explored through probabilistic sensitivity analysis.

Results: In the general-risk female (male) population, the incremental cost per Quality Adjusted Life Year (QALY) was $11,722 ($47,426) for hip protectors. In the male high-risk population, the incremental cost per QALY was $17,017 for hip protectors. In the female high-risk population, hip protectors were cost-saving. Vitamin D and calcium alone was dominated by hip protectors in all four subgroups.

Conclusions: Current information available on interventions to prevent fractures in the elderly in the United Kingdom, suggests that, at the decision-maker's ceiling ratio of $20,000 per QALY, hip protectors are cost-effective in the general female population and high-risk male population, and cost-saving in the high-risk female population, despite the low compliance rate with the treatment.

Type
GENERAL ESSAYS
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ankjaer-Jensen A Johnell O. 1996 Prevention of osteoporosis: Cost-effectiveness of different pharmaceutical treatments. Osteoporos Int. 6: 265275.Google Scholar
Barrett JA Baron JA Karagas MR Beach ML. 1999 Fracture risk in the U.S. Medicare population. J Clin Epidemiol. 52: 243249.Google Scholar
Beck JR, Pauker SG. 1983 The Markov process in medical prognosis. Med Decis Making. 3: 419458.Google Scholar
Bendich A, Leader S, Muhuri P. 1999 Supplemental calcium for the prevention of hip fracture: Potential health economic benefits. Clin Ther. 21: 10581072.Google Scholar
Brazier Je, Green C, Kanis JA. 2002 A systematic review of health state utility values for osteoporosis-related conditions. Osteoporos Int. 13: 768776.Google Scholar
Brazier JE, Kohler B, Walters S. 2000 A prospective study of the health related quality of life impact of hip fractures. Sheffield: Scharr, University of Sheffield
Briggs AH. 2000 Handling uncertainty in cost-effectiveness models. Pharmacoeconomics. 17: 479500.Google Scholar
Chapuy MC, Arlot ME, Duboeuf F, et al. 1992 Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 327: 16371642.Google Scholar
Claxton K. 1999 The Irrelevance Of Inference: A Decision-Making Approach To The Stochastic Evaluation Of Health Care Technologies. J Health Econ. 18: 341364.Google Scholar
Claxton K, Neumann PJ, Araki SS. 2001 The value of information: An application to a policy model of Alzheimer's disease. Int J Technol Assess Health Care. 17: 3855.Google Scholar
Claxton K, Sculpher M, Drummond M. 2002 A rational framework for decision making by the National Institute For Clinical Excellence (NICE). Lancet. 360: 711715.Google Scholar
Cooper C. 1993 Epidemiology and public health impact of osteoporosis. Baillieres Clin Rheumatol. 7: 459477.Google Scholar
Cooper C, Atkinson EJ, Jacobsen SJ, et al. 1993 Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 137: 10011005.Google Scholar
Daly E, Vessey MP, Barlow D, et al. 1996 Hormone replacement therapy in a risk-benefit perspective. Maturitas. 23: 247259.Google Scholar
Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. 1997 Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 337: 670676.Google Scholar
Department of Health. 2003. Departmental Report 2000–2001. Available at: www.doh.gov.uk. Accessed May 10
Dolan P, Torgerson DJ. 1998 The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporos Int. 8: 611617.Google Scholar
Donaldson LJ, Cook A, Thomson RG. 1990 Incidence of fractures in a geographically defined population. J Epidemiol Community Health. 44: 241245.Google Scholar
Doubilet P, Begg CB, Weinstein MC, et al. 1985 Probabilistic sensitivity analysis using Monte Carlo simulation. Med Decis Making. 5: 157177.Google Scholar
Drummond MF, Torrance GW, Stoddart GL. 1995 Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press
European Commission. 1998 Report on osteoporosis in the European Community-action for prevention. Luxembourg: Office for the Official Publications of European Communities
Felli JC, Hazen GB. 1998 Sensitivity analysis and the expected value of perfect information. Med Decis Making. 18: 95109.Google Scholar
Fenwick E, Claxton K, Sculpher M. 2001 Representing uncertainty: The role of cost-effectiveness acceptability curves. Health Econ. 10: 779787.Google Scholar
Geelhoed E, Harris A, Prince R. 1994 Cost-effectiveness analysis of hormone replacement therapy and lifestyle intervention for hip fracture. Aust J Public Health. 18: 153160.Google Scholar
Gillepsie WJ, Avenell A, Henry DA, et al. 2001 Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis (Cochrane Review). Oxford: The Cochrane Library
Government's Actuary Department. 2003. Interim Life Tables 1997–1999. Available at: www.gad.gov.uk. Accessed May 10
Kanis JA, McCloskey EV. 1992; Epidemiology of vertebral osteoporosis. Bone. 13 (suppl 2): S1S10.Google Scholar
Kanis JA, Pitt FA. 1992; Epidemiology of osteoporosis. Bone. 13 (suppl 1): S7S15.Google Scholar
Klotzbuecher CM, Ross PD, Landsman PB, et al. 2001 Patients with prior fractures have an increased risk of future fractures: A summary of the literature and statistical analysis. J Bone Miner Res. 15: 727.Google Scholar
Krahn MD, Naglie G, Naimark D, et al. 1997 Primer on medical decision analysis. IV. Analyzing the model and interpreting the results. Med Decis Making. 17: 142151.Google Scholar
McColl A, Roderick P, Cooper C. 1998 Hip fracture incidence and mortality in an English region: A study using routine National Health Service data. J Public Health Med. 20: 196205.Google Scholar
Meltzer D. 1997 Accounting for future costs in medical cost-effectiveness analysis. J Health Econ. 16: 3364.Google Scholar
Meyer G, Warnke A, Bender R, Muhlhauser I. 2003 Effect on hip fractures of increased use of hip protectors in nursing homes: Cluster randomised controlled trial. BMJ. 326: 76.Google Scholar
Miller DK, Homan SM. 1994 Determining transition probabilities: Confusion and suggestions. Med Decis Making. 14: 5258.Google Scholar
Monthly Index of Medical Specialities (MIMS). 2002
National Statistics. Census 2001. Available at: www.statistics.gov.uk/census2001. Accessed May 10, 2003.
Parker MJ, Gillespie LD, Gillespie WJ. 2001. Hip protectors for preventing hip fractures in the elderly. Oxford: The Cochrane Library
Ray NF, Chan JK, Thamer M, Melton LJI. 1997 Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: Report from the National Osteoporosis Foundation. J Bone Miner Res. 12: 2435.Google Scholar
Rodriguez EC, Fidalgo Garcia ML, Rubio CS. 1999 [A cost-effectiveness analysis of alendronate compared to placebo in the prevention of hip fracture]. Aten Primaria. 24: 390396.Google Scholar
Rossouw JE, Anderson GL, Prentice RL, et al. 2002 Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women' Health Initiative randomized controlled trial. JAMA. 288: 321333.Google Scholar
Sculpher M, Fenwick E, Claxton K. 2000 Assessing quality in decision analytic cost-effectiveness models. A suggested framework and example of application. Pharmacoeconomics. 17: 461477.Google Scholar
Segui-Gomez M, Keuffel E, Frick KD. 2002 Cost and effectiveness of hip protectors among the elderly. Int J Technol Assess Health Care. 18: 5566.Google Scholar
Singer BR, McLauchlan GJ, Robinson CM, Christie J. 1998 Epidemiology of fractures in 15,000 adults: The influence of age and gender. J Bone Joint Surg Br. 80: 243248.Google Scholar
Torgerson DJ, Donaldson C, Reid D. 1996 Using economics to prioritize research: A case study of randomized trials for the prevention of hip fractures due to osteoporosis. J Health Serv Res Policy. 1: 141146.Google Scholar
Torgerson DJ, Kanis JA. 1995 Cost-effectiveness of preventing hip fractures in the elderly population using vitamin D and calcium. QJM. 88: 135139.Google Scholar
Torgerson DJ, Porthouse J. 2003 Effectiveness of hip protectors. Results may not be generalisable to the community. BMJ. 326: 930.Google Scholar
Trivedi DP, Doll R, Khaw KT. 2003 Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: Randomised double blind controlled trial. BMJ. 326: 469.Google Scholar
Van Hout BA, Al MJ, Gordon GS, Rutten FFH. 1994 Costs, effects and C/E ratios alongside a clinical trial. Health Econ. 3: 309319.Google Scholar
van Schoor NM, Deville WL, Bouter LM, Lips P. 2002 Acceptance and compliance with external hip protectors: A systematic review of the literature. Osteoporos Int. 13: 917924.Google Scholar
van Schoor NM, Smit JH, Twisk JW, et al. 2003 Prevention of hip fractures by external hip protectors: A randomized controlled trial. JAMA. 289: 19571962.Google Scholar
van Staa TP, Dennison EM, Leufkens HG, Cooper C. 2001 Epidemiology of fractures in England and Wales. Bone. 29: 517522.Google Scholar
Willis MS. 2002 The health economics of calcium and vitamin D3 for the prevention of osteoporotic hip fractures in Sweden. Int J Technol Assess Health Care. 18: 791807.Google Scholar