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Cost-effective of treatment post menopausal osteoporotic hip fracture : French health system perspective

Isabelle Durand-Zaleski, Kazem Alzahouri, Stéphane Bahrami, Francis Guillemin, Christian Roux

Background : The WHO has introduced a new fracture prediction algorithm (FRAX™) to determine a patient’s absolute (%) fracture risk. Several articles have addressed the economic value of specific agents and suggested that osteoporosis treatment could be based on 10-year fracture probability, as in the FRAX™ algorithm, rather than on T-scores, age and the number of risk factors.

Objective : to evaluate the cost-effectiveness of changing treatment thresholds for women presenting a risk of post menopausal osteoporotic hip fracture, and to estimate the National Health Insurance budget impact of providing a treatment according to FRAX hip fracture probability thresholds for French women.

Study design : Markov modeling with 4 health states, using published data on hip fracture probability, National insurance health care cost and quality adjusted life years (QALYs).

Intervention : Five years of alendronate therapy in patients with a known FRAX score.

Outcomes : number of hip fracture, costs, quality-adjusted life-years, incremental cost-effectiveness ratios and budget impact.

Method : A Markov cohort model of annual age-specific incidence of hip fracture to assess the cost effectiveness of three strategies of treating women according to 10-year fracture probability.

Strategy I : (current practice) based on the identification of individuals with at least one major risk factor with treatment being offered. The definition of risk factors is based on the recommendations published by the French National Authority for Health (Haute Autorité de santé HAS). The treatment is recommended for women with a prior fragility fracture. This current practice results in treatment of women with a FRAX 10-year hip fracture probability of 10%

Strategy II : offering treatment in patients with a FRAX 10-year hip fracture probability of 7 %

Strategy III : offering treatment in patients with a FRAX 10-year hip fracture probability of 3%

Base case : the definition of base case is based on the recommendations published by the French National Health Authority (HAS). Physicians currently identify women with risk factors for osteoporosis and prescribe a measurement of Bone Mineral Density BMD. Treatment is considered in women whose BMD value that lies within the range of osteoporosis. Treatment is, however, also recommended for women with a prior fragility fracture without necessarily measuring BMD. So, the base case is a 50 year-old postmenopausal women with a prior fragility fracture and low BMD. She will be followed for 50 years or death. All women are assumed to have BMD t score ≤−2.5 and to be correctly and effectively treated with alendronate.

Schedule of due dates :

Started : January 2009

Concluded : January 2010

Dernière mise à jour le 21/01/2010