Si L, Winzenberg T M, Jiang Q, Palmer A J
Menzies Research Institute Tasmania, University of Tasmania, Medical Science 1 Building, 17 Liverpool St (Private Bag 23), Hobart, TAS, 7000, Australia,
Osteoporos Int. 2015 May;26(5):1477-89. doi: 10.1007/s00198-014-2999-4. Epub 2015 Jan 8.
This study aimed to document and validate a new cost-effectiveness model of osteoporosis screening and treatment strategies. The state-transition microsimulation model demonstrates strong internal and external validity. It is an important tool for researchers and policy makers to test the cost-effectiveness of osteoporosis screening and treatment strategies.
The objective of this study was to document and validate a new cost-effectiveness model of screening for and treatment of osteoporosis.
A state-transition microsimulation model using a lifetime horizon was constructed with seven Markov states (no history of fractures, hip fracture, vertebral fracture, wrist fracture, other fracture, postfracture state, and death) describing the most important clinical outcomes of osteoporotic fractures. Tracker variables were used to record patients' history, such as fracture events, duration of treatment, and time since last screening. The model was validated for Chinese postmenopausal women receiving screening and treatment versus no screening. Goodness-of-fit analyses were performed for internal and external validation. External validity was tested by comparing life expectancy, osteoporosis prevalence rate, and lifetime and 10-year fracture risks with published data not used in the model.
The model represents major clinical facets of osteoporosis-related conditions. Age-specific hip, vertebral, and wrist fracture incidence rates were accurately reproduced (the regression line slope was 0.996, R(2) = 0.99). The changes in costs, effectiveness, and cost-effectiveness were consistent with changes in both one-way and probabilistic sensitivity analysis. The model predicted life expectancy and 10-year any major osteoporotic fracture risk at the age of 65 of 19.01 years and 13.7%, respectively. The lifetime hip, clinical vertebral, and wrist fracture risks at age 50 were 7.9, 29.8, and 18.7% respectively, all consistent with reported data.
Our model demonstrated good internal and external validity, ensuring it can be confidently applied in economic evaluations of osteoporosis screening and treatment strategies.
本研究旨在记录并验证一种骨质疏松症筛查与治疗策略的新成本效益模型。状态转换微观模拟模型显示出较强的内部和外部有效性。它是研究人员和政策制定者测试骨质疏松症筛查与治疗策略成本效益的重要工具。
本研究的目的是记录并验证一种新的骨质疏松症筛查与治疗成本效益模型。
构建了一个使用终生视角的状态转换微观模拟模型，该模型有七个马尔可夫状态（无骨折史、髋部骨折、椎体骨折、腕部骨折、其他骨折、骨折后状态和死亡），描述骨质疏松性骨折的最重要临床结局。追踪变量用于记录患者的病史，如骨折事件、治疗持续时间和上次筛查后的时间。该模型针对接受筛查和治疗与未接受筛查的中国绝经后女性进行了验证。进行了拟合优度分析以进行内部和外部验证。通过将预期寿命、骨质疏松症患病率、终生和10年骨折风险与模型中未使用的已发表数据进行比较来测试外部有效性。
该模型代表了骨质疏松症相关病症的主要临床方面。特定年龄的髋部、椎体和腕部骨折发病率得到了准确再现（回归线斜率为0.996，R(2)=0.99）。成本、效果和成本效益的变化与单向和概率敏感性分析中的变化一致。该模型预测65岁时的预期寿命和10年任何主要骨质疏松性骨折风险分别为19.01年和13.7%。50岁时终生髋部、临床椎体和腕部骨折风险分别为7.9%、29.8%和18.7%，均与报告数据一致。
我们的模型显示出良好的内部和外部有效性，确保其可自信地应用于骨质疏松症筛查与治疗策略的经济评估。
