Department of Oncology and Metabolism University of Sheffield, Sheffield, UK; Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy.
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Bone. 2022 May;158:116347. doi: 10.1016/j.bone.2022.116347. Epub 2022 Feb 5.
In Sheffield (UK), we introduced the PINP monitoring algorithm for the management of osteoporosis treatment delivered in primary care. Our aims were to evaluate whether this algorithm was associated with better osteoporosis outcomes and was cost-effective compared to standard care.
Inclusion criteria were referral from Sheffield GPs, BMD scans performed between 2012 and 2013 and a report advising initiation of oral bisphosphonate and PINP monitoring. 906 patients were identified and retrospectively divided into Group A (intention to monitor, with baseline PINP, n = 588) and Group B (no intention to monitor, without baseline PINP, n = 318). The model described by Davis and colleagues was used to extrapolate life-time costs and quality-adjusted life-years (QALYs).
No differences were found in baseline characteristics between groups (age, gender, BMI, BMD and major risk factors for fractures). More patients in Group A started oral treatment (77.4% vs 49.1%; p < 0.001), but there were no differences between groups in the presence of a gap in treatment >3 months or in treatment duration. Patients in Group A were more likely to have follow-up DXA scan at 4-6 years from baseline (46.9% vs 29.2%; p < 0.000) and had a greater increase in total hip BMD (+2.74% vs + 0.42%; p value = 0.003). Fewer new fractures occurred in Group A but this was not statistically significant, but the numbers of fractures were small. Patients in Group A were more likely to change management (p = 0.005) including switching to zoledronate (p = 0.03). The PINP measurement and increased prescribing in Group A resulted in increases in both costs (£30.19) and QALYs (0.0039) relative to Group B, giving an incremental cost effectiveness ratio (ICER) of £7660 in the probabilistic sensitivity analysis.
Patients monitored with PINP are more likely to start oral bisphosphonate treatment, switch to zoledronate, have follow-up DXA scans and a greater increase of hip BMD. PINP monitoring has the potential to be cost-effective in a UK NHS setting given that interventions with an ICER under £20,000 are generally considered to be cost-effective.
在英国谢菲尔德，我们引入了 PINP 监测算法来管理初级保健中提供的骨质疏松症治疗。我们的目的是评估与标准护理相比，该算法是否与更好的骨质疏松症结果相关，并且是否具有成本效益。
纳入标准为谢菲尔德全科医生转诊、2012 年至 2013 年期间进行的 BMD 扫描以及建议开始口服双膦酸盐和 PINP 监测的报告。确定了 906 名患者，并回顾性地将其分为 A 组（有监测意向，具有基线 PINP，n=588）和 B 组（无监测意向，无基线 PINP，n=318）。使用戴维斯等人描述的模型来推断终生成本和质量调整生命年（QALY）。
两组之间在基线特征方面没有差异（年龄、性别、BMI、BMD 和骨折的主要危险因素）。A 组中开始口服治疗的患者更多（77.4% vs 49.1%；p<0.001），但两组之间在治疗>3 个月的空白或治疗持续时间方面没有差异。A 组的患者更有可能在基线后 4-6 年进行随访 DXA 扫描（46.9% vs 29.2%；p<0.000），总髋部 BMD 增加更多（+2.74% vs +0.42%；p 值=0.003）。A 组发生的新骨折较少，但这没有统计学意义，但骨折数量较少。A 组的患者更有可能改变管理（p=0.005），包括改用唑来膦酸（p=0.03）。与 B 组相比，A 组的 PINP 测量和增加的处方导致成本（30.19 英镑）和 QALY（0.0039）均增加，在概率敏感性分析中增量成本效益比（ICER）为 7660 英镑。
接受 PINP 监测的患者更有可能开始口服双膦酸盐治疗、改用唑来膦酸、进行随访 DXA 扫描和髋部 BMD 增加更多。鉴于具有低于 20000 英镑 ICER 的干预措施通常被认为具有成本效益，因此在英国 NHS 环境中，PINP 监测具有潜在的成本效益。
