Univ Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France.
Hospices Civils de Lyon, Pôle de Santé Publique, 69003, Lyon, France.
Arch Osteoporos. 2020 Mar 7;15(1):42. doi: 10.1007/s11657-020-00720-9.
Osteoporosis (OP) is responsible for an important economic burden, but OP care is far from meeting therapeutic guidelines. Some interventions were effective to improve OP management. Our objective was to evaluate the cost-effectiveness of these interventions. Structural interventions and interventions consisting in sending educational material were dominant strategies.
Osteoporosis (OP) causes many osteoporotic fractures worldwide and an important economic burden as a result. OP care is far from meeting treatment guidelines, but in a recent meta-analysis, we showed that some interventions were effective to improve appropriate bone mineral density (BMD) and treatment prescriptions. In the context of limited resources, it is of major importance to measure these interventions' efficiency. Our objective was to evaluate the cost-effectiveness of existing effective intervention types.
We used a decision tree incorporating Markov models to compare costs and benefits (quality-adjusted life-years or QALYs) between usual care and three intervention types: structural (I), direct educational through conversation (II), and indirect educational by sending material (III). We adopted the collectivity perspective and chose a 30-year time horizon. The model included efficacy of interventions and risk of further fracture or death, depending on BMD T-score results and OP management, obtained from published literature. The model was populated to reflect a French setting. Deterministic and probabilistic sensitivity analyses were conducted. Costs were presented in 2018 euros (€).
Interventions type I and III were dominant strategies compared with usual care (cost-saving with a QALY gain). Our results were consistent through sensitivity analyses.
Our results suggest that structural interventions and indirect interventions to improve OP care (BMD and OP treatment prescription), in women 50 years old with a first fragility fracture, were dominant strategies.
骨质疏松症（OP）在全球范围内导致许多骨质疏松性骨折，并因此造成了巨大的经济负担。OP 治疗远未达到治疗指南的要求，但在最近的一项荟萃分析中，我们发现一些干预措施可以有效改善适当的骨密度（BMD）和治疗处方。在资源有限的情况下，衡量这些干预措施的效率非常重要。我们的目的是评估现有的有效干预类型的成本效益。
我们使用决策树结合 Markov 模型，比较了常规护理与三种干预类型（结构性干预、直接通过对话进行的教育干预和间接通过发送材料进行的教育干预）之间的成本和效益（质量调整生命年或 QALY）。我们采用了集体视角，并选择了 30 年的时间范围。该模型包括干预措施的疗效和根据 BMD T 评分结果以及 OP 管理发生进一步骨折或死亡的风险，这些结果来自已发表的文献。该模型根据法国的情况进行了填充。进行了确定性和概率敏感性分析。成本以 2018 年欧元（€）表示。
与常规护理相比，干预类型 I 和 III 是占优策略（节省成本并获得 QALY 收益）。我们的结果通过敏感性分析得到了一致的验证。
我们的结果表明，结构性干预和间接干预措施可以改善 OP 治疗（BMD 和 OP 治疗处方），对于 50 岁首次脆性骨折的女性，是占优策略。
