RESEARCH - Individual fracture risk and the cost-effectiveness of bisphosphonates in patients using oral steroids

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Rheumatology (Oxford). 2007 Mar;46(3):460-6. Epub 2006 Aug 9.

Individual fracture risk and the cost-effectiveness of bisphosphonates

in patients using oral glucocorticoids.

van Staa TP, Geusens P, Zhang B, Leufkens HG, Boonen A, C.

Utrecht Institute for Pharmaceutical Sciences, Utrecht University,

Utrecht, The Netherlands.

OBJECTIVES: There are few data on the cost-effectiveness of

bisphosphonates with oral glucocorticoids (GCs). An individual

patient-based pharmaco-economic model was developed. METHODS: Data

were obtained from a cohort of oral GC users aged 40+ (n = 190 000) in

the UK General Practice Research Database. Individualized fracture and

mortality risks were calculated specific for age, sex, daily and

cumulative GC dose, indication and other clinical risk factors. UK

costs of medication and direct costs of fracture were obtained from

National Institute for Clinical Excellence and used to estimate costs

per quality-adjusted life-year (QALY) gained and fracture prevented

for bisphosphonates in patients treated for 5 yrs with GCs. RESULTS:

With the use of 5 mg GCs daily, the cost per one QALY gained with

bisphosphonates was 41k UK pounds (95% confidence intervals 22-72k) in

women aged <60 [men 40k pounds (29-54k)], 17k pounds (13-24k) in women

aged 60-79 [men 43k pounds (31-60k)], 5k pounds(3-6k) in women aged

80+ [men 35k pounds (25-46k)]. With 15 mg GC, these figures were 17k

pounds (14-21k), 13k pounds (10-16k) and 15k pounds (9-26k) in women

and 22k pounds (17-26k), 34 pounds (23-53k) and 33k pounds (27-42k) in

men, respectively. When stratifying by overall fracture risk and life

expectancy at the start of GC therapy, cost per QALY increased with

decreasing life expectancy. Patients with rheumatoid arthritis had

comparatively better cost-effectiveness, given higher fracture risk

and better life expectancy.

CONCLUSIONS: The cost-effectiveness of bisphosphonates varied

substantially. Bisphosphonates can be considered cost-effective in

patients with higher fracture risks, such as elderly patients (with a

life expectancy over 5 yrs), and younger patients with a fracture

history, low body mass index, rheumatoid arthritis or using high GC

doses.

http://www.ncbi.nlm.nih.gov/pubmed/16899499

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