Osteoporosis Policlinic, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Osteoporos Int. 2012 Nov;23(11):2579-89. doi: 10.1007/s00198-011-1869-6. Epub 2012 Jan 6.
FRAX-based cost-effective intervention thresholds in the Swiss setting were determined. Assuming a willingness to pay at 2× Gross Domestic Product per capita, an intervention aimed at reducing fracture risk in women and men with a 10-year probability for a major osteoporotic fracture at or above 15% is cost-effective.
The fracture risk assessment algorithm FRAX® has been recently calibrated for Switzerland. The aim of the present analysis was to determine FRAX-based fracture probabilities at which intervention becomes cost-effective.
A previously developed and validated state transition Markov cohort model was populated with Swiss epidemiological and cost input parameters. Cost-effective FRAX-based intervention thresholds (cost-effectiveness approach) and the cost-effectiveness of intervention with alendronate (original molecule) in subjects with a FRAX-based fracture risk equivalent to that of a woman with a prior fragility fracture and no other risk factor (translational approach) were calculated based on the Swiss FRAX model and assuming a willingness to pay of 2 times Gross Domestic Product per capita for one Quality-adjusted Life-Year.
In Swiss women and men aged 50 years and older, drug intervention aimed at decreasing fracture risk was cost-effective with a 10-year probability for a major osteoporotic fracture at or above 13.8% (range 10.8% to 15.0%) and 15.1% (range 9.9% to 19.9%), respectively. Age-dependent variations around these mean values were modest. Using the translational approach, treatment was cost-effective or cost-saving after the age 60 years in women and 55 in men who had previously sustained a fragility fracture. Using the latter approach leads to considerable underuse of the current potential for cost-effective interventions against fractures.
Using a FRAX-based intervention threshold of 15% for both women and men should permit cost-effective access to therapy to patients at high fracture probability based on clinical risk factors and thereby contribute to further reduce the growing burden of osteoporotic fractures in Switzerland.
确定瑞士基于 FRAX 的具有成本效益的干预阈值。假设支付意愿为人均国内生产总值的 2 倍，那么针对女性和男性的骨折风险干预措施是有效的，这些人在 10 年内发生主要骨质疏松性骨折的概率为 15%或更高。
FRAX®骨折风险评估算法最近已经在瑞士进行了校准。本分析的目的是确定基于 FRAX 的骨折概率，在此概率下干预具有成本效益。
使用之前开发并验证的状态转移马尔可夫队列模型，结合瑞士的流行病学和成本输入参数进行填充。使用瑞士 FRAX 模型，根据基于 FRAX 的骨折风险相当于先前发生脆性骨折且无其他风险因素的女性的骨折风险，计算了基于 FRAX 的成本效益干预阈值（成本效益方法）和用阿仑膦酸钠（原分子）进行干预的成本效益（转化方法），假设对一个质量调整生命年的支付意愿为人均国内生产总值的 2 倍。
在瑞士，年龄在 50 岁及以上的女性和男性中，药物干预降低骨折风险的成本效益为 10 年内发生主要骨质疏松性骨折的概率为 13.8%（范围为 10.8%至 15.0%）和 15.1%（范围为 9.9%至 19.9%）。这些平均值的年龄依赖性变化幅度不大。使用转化方法，在年龄达到 60 岁的女性和 55 岁的男性中，治疗在发生脆性骨折后具有成本效益或成本节约。使用后一种方法会导致对当前具有成本效益的骨折干预措施的潜在利用不足。
对于女性和男性，使用基于 FRAX 的 15%的干预阈值应允许基于临床危险因素，对骨折高概率患者进行具有成本效益的治疗，从而有助于进一步降低瑞士骨质疏松性骨折的不断增长的负担。
