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An economic evaluation: Simulation of the cost/effectiveness and cost/utility of universal prevention strategies against osteoporosis-related fractures

Léon Nshimyumukiza, Audrey Durand, Mathieu Gagnon, Xavier Douville, Suzanne Morin, Carmen Lindsay, Julie Duplantie, Christian Gagné, Sonia Jean, Yves Giguère, Sylvie Dodin, François Rousseau and Daniel Reinharz
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Abstract - A patient-level Markov decision model was used to simulate a virtual cohort of 500 000 women 40 years-old and over, in relation to osteoporosis-related hip, clinical vertebral and wrist bone fractures events. 16 different screening options of three main scenario groups were compared: i) the status quo (no specific national prevention program), ii) a universal primary prevention program iii) a universal screening and treatment program based on the 10-year absolute risk of fracture. The outcomes measured were total directs costs in perspective of public health care system, number of fractures and quality-adjusted life years. Results show that an option consisting of a program promoting physical activity and treatment if a fracture occurs is the most C/E (cost/fracture averted) alternative and also the only cost saving one especially for women 40 to 64 years old. In women who are 65 years and over, BMD based screening and treatment based on the 10-year absolute fracture risk calculated using Canadian association of radiologists and Osteoporosis Canada (CAROC) tool is the best next alternative. In terms of C/U, results were similar. For women of less than 65 years old, a program promoting physical activity emerged also as cost-saving but BMD-based screening with pharmacological treatment also emerged as an interesting alternative. In conclusion, a program promoting physical activity is the most C/E and C/U option for women of 40 to 64 years. BMD screening and pharmacological treatment might be considered as a reasonable alternative for women of 65 years and over as at a healthcare capacity to pay of CAD $ 50000 for additional fracture averted or for one QALY gained its probabilities of cost/effectiveness compared to the program promoting physical activity are 63% and 75% respectively which could be considered socially acceptable. Consideration of the indirect costs could change these findings.

Bibtex:

@article{Nshimyumukiza947,
author    = { Léon Nshimyumukiza and Audrey Durand and Mathieu Gagnon and Xavier Douville and Suzanne Morin and Carmen Lindsay and Julie Duplantie and Christian Gagné and Sonia Jean and Yves Giguère and Sylvie Dodin and François Rousseau and Daniel Reinharz },
title     = { An economic evaluation: Simulation of the cost/effectiveness and cost/utility of universal prevention strategies against osteoporosis-related fractures },
volume    = { 28 },
number    = { 2 },
pages     = { 383-394 },
year      = { 2013 },
month     = { 2 },
journal   = { Journal of Bone and Mineral Research },
web       = { http://dx.doi.org/10.1002/jbmr.1758 }
}

Dernière modification: 2012/10/30 par cgagne

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