Department of Medical Statistics, Kobe Pharmaceutical University, 4-19-1, Motoyamakita, Higashinada, Kobe, 658-8558, Japan.
Center for Health Economics and QOL Research, 1398, Shimami, Kita-ku, Niigata, 950-3198, Japan.
Osteoporos Int. 2017 Feb;28(2):621-632. doi: 10.1007/s00198-016-3777-2. Epub 2016 Oct 4.
A model-based cost-effectiveness analysis was performed to evaluate the cost-effectiveness of secondary fracture prevention by osteoporosis liaison service (OLS) relative to no therapy in patients with osteoporosis and a history of hip fracture. Secondary fracture prevention by OLS is cost-effective in Japanese women with osteoporosis who have suffered a hip fracture.
The purpose of this study was to estimate, from the perspective of Japan's healthcare system, the cost-effectiveness of secondary fracture prevention by OLS relative to no therapy in patients with osteoporosis and a history of hip fracture.
A patient-level state transition model was developed to predict lifetime costs and quality-adjusted life years (QALYs) in patients with or without secondary fracture prevention by OLS. The incremental cost-effectiveness ratio (ICER) of secondary fracture prevention compared with no therapy was estimated. Sensitivity analyses were performed to examine the influence of parameter uncertainty on the base case results.
Compared with no therapy, secondary fracture prevention in patients aged 65 with T-score of -2.5 resulted in an additional lifetime cost of $3396 per person and conferred an additional 0.118 QALY, resulting in an ICER of $28,880 per QALY gained. Deterministic sensitivity analyses showed that treatment duration and offset time strongly affect the cost-effectiveness of OLS. According to the results of scenario analyses, secondary fracture prevention by OLS was cost-saving compared with no therapy in patients with a family history of hip fracture and high alcohol intake.
Secondary fracture prevention by OLS is cost-effective in Japanese women with osteoporosis who have suffered a hip fracture. In addition, secondary fracture prevention is less expensive than no therapy in high-risk patients with multiple risk factors.
本研究旨在从日本医疗保健系统的角度，评估骨质疏松症联络服务（OLS）对髋部骨折后骨质疏松症患者进行二级骨折预防相对于无治疗的成本效益。
开发了一个患者水平的状态转移模型，以预测接受或不接受 OLS 二级骨折预防的患者的终生成本和质量调整生命年（QALYs）。估计了与无治疗相比，二级骨折预防的增量成本效益比（ICER）。进行了敏感性分析，以检查参数不确定性对基本情况结果的影响。
与无治疗相比，T 评分为-2.5 的 65 岁患者接受 OLS 二级骨折预防治疗，每人额外增加终生成本 3396 美元，并额外获得 0.118 个 QALY，ICER 为每获得一个 QALY 增加 28880 美元。确定性敏感性分析表明，治疗持续时间和偏移时间对 OLS 的成本效益有很大影响。根据情景分析的结果，对于有髋部骨折家族史和大量饮酒的患者，OLS 二级骨折预防相对于无治疗是节省成本的。
对于经历过髋部骨折的日本骨质疏松症女性，OLS 二级骨折预防具有成本效益。此外，对于具有多种危险因素的高危患者，二级骨折预防比无治疗更便宜。
