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Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA.
Osteoporos Int. 2017 02; 28(2):585-595.OI

Abstract

We developed a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women without prior major osteoporotic fractures over a lifetime horizon. At ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a conventionally accepted threshold compared with bisphosphonates alone.

INTRODUCTION

The purpose of this study was to examine the cost-effectiveness of the combined strategy of oral bisphosphonate therapy for 5 years and falls prevention exercise for 1 year compared with either strategy in isolation.

METHODS

We calculated incremental cost-effectiveness ratios [ICERs] (2014 US dollars per quality-adjusted life year [QALY]), using a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women with different starting ages (65, 70, 75, and 80) without prior history of hip, vertebral, or wrist fractures over a lifetime horizon from the societal perspective.

RESULTS

At ages 65, 70, 75, and 80, the combined strategy had ICERs of $202,020, $118,460, $46,870, and $17,640 per QALY, respectively, compared with oral bisphosphonate therapy alone. The combined strategy provided better health at lower cost than falls prevention exercise alone at ages 70, 75, and 80. In deterministic sensitivity analyses, results were particularly sensitive to the change in the opportunity cost of participants' time spent exercising. In probabilistic sensitivity analyses, the probabilities of the combined strategy being cost-effective compared with the next best alternative increased with age, ranging from 35 % at age 65 to 48 % at age 80 at a willingness-to-pay of $100,000 per QALY.

CONCLUSIONS

Among community-dwelling US white women ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a willingness-to-pay of $100,000 per QALY, compared with oral bisphosphonate therapy only. This analysis will help clinicians and policymakers make better decisions about treatment options to reduce fracture risk.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Mori T
Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan. takahiromori@outlook.com. Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba City, Ibaraki, Japan. takahiromori@outlook.com. Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan. takahiromori@outlook.com.
Crandall CJ
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Ganz DA
Geriatric Research, Education and Clinical Center and HSR&D Center for Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA. Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA. Health Unit, RAND Corporation, Santa Monica, CA, USA.

MeSH

Accidental FallsAdministration, OralAgedAged, 80 and overBone Density Conservation AgentsCombined Modality TherapyCost-Benefit AnalysisDiphosphonatesDrug CostsExercise TherapyFemaleHealth Care CostsHumansJapanMarkov ChainsOsteoporosis, PostmenopausalOsteoporotic FracturesQuality-Adjusted Life YearsSensitivity and Specificity

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27726000

Citation

Mori, T, et al. "Cost-effectiveness of Combined Oral Bisphosphonate Therapy and Falls Prevention Exercise for Fracture Prevention in the USA." Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, vol. 28, no. 2, 2017, pp. 585-595.
Mori T, Crandall CJ, Ganz DA. Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA. Osteoporos Int. 2017;28(2):585-595.
Mori, T., Crandall, C. J., & Ganz, D. A. (2017). Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA. Osteoporosis International : a Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 28(2), 585-595. https://doi.org/10.1007/s00198-016-3772-7
Mori T, Crandall CJ, Ganz DA. Cost-effectiveness of Combined Oral Bisphosphonate Therapy and Falls Prevention Exercise for Fracture Prevention in the USA. Osteoporos Int. 2017;28(2):585-595. PubMed PMID: 27726000.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA. AU - Mori,T, AU - Crandall,C J, AU - Ganz,D A, Y1 - 2016/10/11/ PY - 2016/01/07/received PY - 2016/09/11/accepted PY - 2016/10/12/pubmed PY - 2018/5/8/medline PY - 2016/10/12/entrez KW - Cost-effectiveness analysis KW - Falls prevention exercise KW - Fracture prevention KW - Oral bisphosphonate therapy KW - Osteoporosis SP - 585 EP - 595 JF - Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA JO - Osteoporos Int VL - 28 IS - 2 N2 - : We developed a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women without prior major osteoporotic fractures over a lifetime horizon. At ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a conventionally accepted threshold compared with bisphosphonates alone. INTRODUCTION: The purpose of this study was to examine the cost-effectiveness of the combined strategy of oral bisphosphonate therapy for 5 years and falls prevention exercise for 1 year compared with either strategy in isolation. METHODS: We calculated incremental cost-effectiveness ratios [ICERs] (2014 US dollars per quality-adjusted life year [QALY]), using a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women with different starting ages (65, 70, 75, and 80) without prior history of hip, vertebral, or wrist fractures over a lifetime horizon from the societal perspective. RESULTS: At ages 65, 70, 75, and 80, the combined strategy had ICERs of $202,020, $118,460, $46,870, and $17,640 per QALY, respectively, compared with oral bisphosphonate therapy alone. The combined strategy provided better health at lower cost than falls prevention exercise alone at ages 70, 75, and 80. In deterministic sensitivity analyses, results were particularly sensitive to the change in the opportunity cost of participants' time spent exercising. In probabilistic sensitivity analyses, the probabilities of the combined strategy being cost-effective compared with the next best alternative increased with age, ranging from 35 % at age 65 to 48 % at age 80 at a willingness-to-pay of $100,000 per QALY. CONCLUSIONS: Among community-dwelling US white women ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a willingness-to-pay of $100,000 per QALY, compared with oral bisphosphonate therapy only. This analysis will help clinicians and policymakers make better decisions about treatment options to reduce fracture risk. SN - 1433-2965 UR - https://www.unboundmedicine.com/medline/citation/27726000/Cost_effectiveness_of_combined_oral_bisphosphonate_therapy_and_falls_prevention_exercise_for_fracture_prevention_in_the_USA_ DB - PRIME DP - Unbound Medicine ER -