Quantify Research, Stockholm, Sweden.
Karolinska Institutet, Stockholm, Sweden.
Osteoporos Int. 2021 Jul;32(7):1301-1311. doi: 10.1007/s00198-020-05765-7. Epub 2021 Jan 7.
A novel cost-effectiveness model framework was developed to incorporate the elevated fracture risk associated with a recent fracture and to allow sequential osteoporosis therapies to be evaluated. Treating patients with severe osteoporosis after a recent fracture with a bone-forming agent followed by antiresorptive therapy can be cost-effective compared with antiresorptive therapy alone. Incorporating these novel technical attributes in economic evaluations can support appropriate policy and reimbursement decision-making.
To develop a cost-effectiveness model accommodating increased fracture risk after a recent fracture and treatment sequencing.
A micro-simulation cost-utility model was developed to accommodate both treatment sequencing and increased risk with recent fracture. The risk of fracture was estimated and simulated using the FRAX® algorithms combined with Swedish registry data on imminent fracture relative risk. In the base-case cost-effectiveness analysis, a sequential treatment starting with a bone-forming agent for 12 months followed by an antiresorptive agent for 48 months initiated immediately after a major osteoporotic fracture (MOF) in a 70-year-old woman with a T-score of 2.5 or less was compared to an antiresorptive treatment alone for 60 months. The model was populated with data relevant for a UK population reflecting a personal social service perspective.
The cost per additional quality-adjusted life year (QALY) gained in the base-case setting was estimated at £34,584. Sensitivity analyses revealed the sequential treatment to be cost-saving compared with administering a bone-forming treatment alone. Without simulating an elevated fracture risk immediately after a recent fracture, the cost per QALY changed from £34,584 to £62,184.
Incorporating imminent fracture risk in economic evaluations has a significant impact on the cost-effectiveness when evaluating fracture prevention treatments in patients with osteoporosis who sustained a recent fracture. Bone-forming treatment followed by antiresorptive therapy can be cost-effective compared to antiresorptive therapy alone depending on treatment acquisition costs.
开发一种能够容纳近期骨折后骨折风险增加和治疗顺序的成本效益模型。
开发了一种微模拟成本效用模型，以适应治疗顺序和近期骨折风险增加。使用 FRAX®算法结合瑞典登记处关于即将发生的骨折相对风险的数据来估计和模拟骨折风险。在基本的成本效益分析中，在 70 岁 T 评分<2.5 的女性发生严重骨质疏松性骨折（MOF）后立即开始，首先进行为期 12 个月的成骨治疗，然后进行为期 48 个月的抗吸收治疗，与单独进行为期 60 个月的抗吸收治疗进行比较。模型使用与英国人群相关的数据进行填充，反映个人社会服务的观点。
在基本情况下，每增加一个质量调整生命年（QALY）的成本估计为 34584 英镑。敏感性分析显示，与单独使用成骨治疗相比，序贯治疗具有成本效益。如果不模拟近期骨折后立即发生的骨折风险，每 QALY 的成本将从 34584 英镑增加到 62184 英镑。
在评估骨质疏松症患者近期骨折后预防骨折治疗的成本效益时，将即将发生的骨折风险纳入经济评估会产生重大影响。成骨治疗后再进行抗吸收治疗可能比单独使用抗吸收治疗更具成本效益，具体取决于治疗获得成本。
