ORIGINAL INVESTIGATION. Osteoporosis Case Manager for Patients With Hip Fractures

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "ORIGINAL INVESTIGATION. Osteoporosis Case Manager for Patients With Hip Fractures"

Transcription

1 ORIGINAL INVESTIGATION Osteoporosis Case Manager for Patients With Hip Fractures Results of a Cost-effectiveness Analysis Conducted Alongside a Randomized Trial Sumit R. Majumdar, MD, MPH; Douglas A. Lier, MA; Lauren A. Beaupre, PhD; David A. Hanley, MD; Walter P. Maksymowych, MD; Angela G. Juby, MB ChB; Neil R. Bell, MD; Donald W. Morrish, MD, PhD Background: In a randomized trial of patients with hip fractures, we previously demonstrated that a hospitalbased case manager could increase rates of appropriate osteoporosis treatment to 51% compared with 22% for usual care (P.001). Alongside that trial, we conducted an economic analysis. Methods: Patients with hip fractures were randomized to usual care (n=110) or a case manager (n=110) and followed up for 1 year. Time-motion studies were used to determine intervention costs. From a third-party health care payer perspective and over the patient s remaining lifetime, a Markov decision-analytic model was constructed to determine cost-effectiveness of the intervention compared with usual care. Costs and benefits were discounted at 3% and expressed in 2006 Canadian dollars. Results: The intervention cost CaD $56 per patient. Compared with usual care, the intervention strategy was dominant: for every 100 patients case managed, 6 fractures (4 hip fractures) were prevented, 4 quality-adjusted lifeyears were gained, and CaD $ was saved by the health care system. Irrespective of the number of patients case managed, the intervention reached a breakeven threshold within 2 years. The intervention dominated usual care over the entire spectrum of 1-way sensitivity analyses and was cost-saving in 82% of probabilistic model simulations. Conclusions: Compared with usual care, we found that using a case manager for patients with hip fractures increased rates of appropriate osteoporosis treatment. The intervention dominated usual care, and the analysis suggests that systems implementing an intervention similar to ours should expect to see a reduction in fractures, gains in life expectancy, and substantial cost savings. Trial Registration: clinicaltrials.gov Identifier: NCT Arch Intern Med. 2009;169(1):25-31 Author Affiliations: Institute of Health Economics (Dr Majumdar and Mr Lier) and Departments of Medicine (Drs Majumdar, Maksymowych, Juby, and Morrish), Rehabilitation Medicine (Dr Beaupre), and Family Medicine (Dr Bell), University of Alberta, Edmonton, Alberta, Canada; and Department of Medicine, University of Calgary, Calgary, Alberta (Dr Hanley). OSTEOPOROSIS IS A COMmon and costly condition, and in 2005 in the United States alone there were more than 2 million fractures costing nearly $17 billion. 1 The most devastating complication of osteoporosis is hip fracture. Those who survive their hip fracture still have a 20% to 30% mortality rate during the next 12 months, a 2- to 3-fold increased risk of future fracture during the next 5 to 10 years, and a 5% to 10% incidence of another hip fracture within the year. 2,3 Treatment with the bisphosphonates alendronate sodium and risedronate sodium is associated with a 40% to 60% relative reduction in risk of future osteoporosisrelated fractures, 4 and the intravenous bisphosphonate zoledronate has even been associated with an all-cause mortality reduction after hip fracture. 3 Unfortunately, in the United States, Canada, and elsewhere, rates of appropriate osteoporosis treatment are less than 10% to 20% in the year after hip fracture. 2,3,5 In a randomized controlled trial conducted in hip fracture survivors, we demonstrated that use of a hospital-based osteoporosis case manager could lead to a 51% rate of bisphosphonate treatment within 6 months of fracture (vs 22% for controls; P.001) and result in 67% of patients receiving guideline-concordant appropriate care (vs 26% for controls; P.001). 2 Although the osteoporosis case manager was effective and led to clinically meaningful improvements in quality of care, physicians, policy makers, and payers may remain unconvinced that the intervention would be worth the effort or cost of implementation. Therefore, alongside our randomized trial, we conducted a formal health economic analysis from the perspective of a third-party health care payer. 25

2 BMD P i =.80 P c =.29 No BMD P i =.20 P c =.71 LBM P i =.76 P c =.81 NBM P i =.24 P c =.19 LBM P i =.77 P c =.77 NBM P i =.23 P c =.23 METHODS DESCRIPTION OF THE RANDOMIZED TRIAL The main study has been published. 2 Briefly, we conducted a population-based study including all 3 hospitals that manage hip fracture in Capital Health (Edmonton, Alberta, Canada). In terms ofqualityofusualsurgicalcareandoutcomesachieved, thesestudy sites are comparable to and representative of other hospitals in Canada. 6 Furthermore,intermsofosteoporosiscarebeforethetrial, our rates of undertreatment 7 were identical to those achieved elsewhere in Canada and the United States. 5 Consecutive patients 50 years or older were included. The main reasons for exclusion were residence in a nursing home(35% of all exclusions), refusal(19%), and bisphosphonate treatment (18%). Eligible patients were randomized to the case manager intervention (n=110) or usual care (n=110). The primary study outcome was starting bisphosphonate therapy within 6 months. Secondary outcomes included bone mineral density (BMD) testing and guideline-concordant appropriatecare, definedasabmdtestperformedandosteoporosistreatment provided to those with low bone mass. COST-EFFECTIVENESS ANALYSIS Overview We hypothesized that the intervention would be cost-effective compared with usual care. Our trial provided data about the population at risk, effectiveness of the intervention, achieved rates of osteoporosis testing and treatment across experimental arms, 1-year Rx P i =.79 P c =.62 No Rx P i =.21 P c =.38 Rx P i =.06 P c =.12 No Rx P i =.94 P c =.88 Figure 1. Decision tree of the model with Markov processes. Probabilities associated with the intervention and control arms of the study are denoted by P i and P c, respectively. BMD indicates bone mineral density; LBM, low bone mass; NBM, normal bone mass; and Rx, treated with alendronate sodium. M1, M2, and M3 refer to the individual Markov processes; also see the Decision Analytic Model subsection of the Methods section and Figure 2. M1 M2 M3 M1 M2 M3 Table 1. Distribution of Patients by Subgroup and Study Arm Subgroup Intervention Control BMD, LBM, Rx BMD, LBM, no Rx BMD, NBM LBM, Rx LBM, no Rx NBM Total a treatment persistence, and direct health resource use related to hip fracture. We then used a decision analysis model incorporating Markov processes to simulate the osteoporosis experience of a cohort of patients with hip fracture similar to those in our trial but followed up over the rest of their projected remaining lifetime horizon Cost-effectiveness was analyzed by estimating incremental cost and effectiveness, based on qualityadjusted life-years gained. Costs were reported from the thirdparty health care payer perspective, acknowledging that Canadians have universal health care coverage that includes prescription medications for this age group. Decision Analytic Model Figure 1 illustrates the 6 osteoporosis-related diagnosis and treatment pathways into which patients were grouped after randomization. The proportion of patients within each group (Table 1) was calculated by multiplying the probabilities along each pathway, with probabilities for the initial distribution ascertained from our trial. Then a Markov process, through which costs and outcomes were modeled, was applied to each of these groups There were 3 unique Markov processes differentiated by their transition probabilities (Figure 1): patients with low bone mass receiving osteoporosis treatment (M1), patients with low bone mass not receiving treatment (M2), and patients with normal bone mass, ie, not eligible for treatment (M3). The M1 and M3 processes represent guidelineconcordant appropriate care for this population. The structure of the Markov process, shown in Figure 2, was adapted from previous work by Johnell and colleagues 10 and the International Osteoporosis Foundation costeffectiveness reference model. 11,12 Our model incorporates 6 health states, simulating the movement of patients from age 74 years until 100 years or death. All patients begin in the post hip fracture state at home, following discharge from the hospital. Once per annual cycle, a proportion of the cohort moves to one of the other 5 states, in accordance with prespecified transition probabilities. These transition probabilities were derived from fracture rates specific to the type of fracture incurred, presence of low bone mass, age-specific death rates, and (for patients receiving bisphosphonate treatment) fracture type specific reductions in future fractures. A half-cycle correction was applied to transitions between health states. 8 Model Assumptions Measured % of Patients Abbreviations: BMD, bone mineral density; LBM, low bone mass; NBM, normal bone mass; Rx, treated with alendronate sodium. a Totals do not sum to because of rounding. We made a number of assumptions. Because of the scarcity of data related to osteoporosis treatments and outcomes for men (35% of our cohort), most of the input data in our model relate to women. Patients with hip fractures were considered to 26

3 Post hip fracture Death Table 2. Cost Assumptions Spine fracture Additional hip fracture Post additional hip fracture have either normal or low bone mass on the basis of measurements of BMD from our trial. Alendronate was the medication prescribed to all treated patients because it is the bisphosphonate that has the greatest weight of evidence for vertebral and nonvertebral fracture reduction, it has a generic formulation, and most treated patients received alendronate sodium, 70 mg weekly. In addition, it was assumed that, once a patient had a second hip fracture, no additional wrist or spine fractures occurred, although repeat hip fractures were permitted. Last, only the Death state was defined as absorbing. Model Inputs Wrist fracture Figure 2. Structure of the Markov process (adapted from Johnell et al, 10 Zethraeus et al, 11 and Ström et al 12 ). There are potential transitions from each health state to the Death state that are not shown in the figure for purposes of clarity. Fracture Rates. Fracture rates were type-specific and assumed to be constant with respect to age. We used the actual hip fracture rates (5.6%) and derived the rates for spine and wrist fractures (2.6% for each) from a large Canadian cohort study conducted in a similar population. 13 We assumed that these rates represented the annual probability of type-specific fracture following a previous hip fracture for patients with untreated low bone mass. We could not find published refracture rates for patients with normal bone mass, and so we considered them to have the same rates of fracture as patients with low bone mass who were taking alendronate. Reductions in Fracture Risk With Treatment. Estimates of reduction in fracture risk with alendronate were obtained from systematic reviews. 4 Alendronate was associated with a 49% relative reduction in risk of hip and spine fractures and a 48% reduction for wrist fractures. 4 In the base-case analysis, alendronate treatment was for 5 years duration. In the first year of treatment, the beneficial effect of alendronate was assumed to be 50% of the full achievable benefit. However, a further residual positive effect of alendronate treatment was assumed to occur for an additional 5 years after discontinuation. 14,15 This residual effect was incorporated as a linear but declining benefit during the 5-year set time after discontinuation of treatment. 14,15 From our study, 1-year persistence with osteoporosis treatment was 85%; we assumed that this would continue for the next 4 years. It was also assumed that the 15% of patients who discontinued treatment did so in the first year and that they received no benefit. Cost Elements for Each of 6 Health States Cost a Prior costs Quality improvement intervention cost b 56 Bone mineral density test c Post hip fracture state 0 2. Additional hip fracture state Acute hospital with physician fees (16 d); all patients Subacute rehabilitation (30 d); 48% of patients Home care (20 h); 48% of patients 900 Long-term care with physician fees (349 d); % of patients 3. Vertebral fracture state Acute hospital with physician fees, follow-up (15 d); % of patients Physician care (2 visits radiography); 90% of patients 188 Outpatient rehabilitation (7 visits); all patients Wrist fracture state Emergency visit with radiography physician fees; 1066 all patients Physician care (2 visits radiography); all patients 149 Outpatient rehabilitation (7 visits); all patients Post additional hip fracture state Long-term care with physician fees (365 d); % of patients 6. Death state 0 Alendronate sodium treatment 291 a cost of all patients receiving each service, per model cycle (1 year). These costs are expressed in constant 2006 Canadian dollars (multiply by 0.88 to convert to US dollars). b One-time cost for all patients in the intervention group. c One-time cost for patients, in either study group, who receive initial bone mineral density test. Costs. All costs were expressed in constant 2006 Canadian dollars. In the base-case analysis, after the first year, all costs and outcomes were discounted at 3% per annum. 16 The 1-time cost of the intervention was based on time-motion studies conducted in a random sample of patients in the trial. 2 The case manager spent a median of 70 minutes per patient divided among 4 activities, including patient education, arranging for and interpreting BMD tests, providing prescriptions and medication counseling, and communicating with the primary care physician. We used the hourly pay scale for middle experience on our local salary grid for a registered nurse (CaD $32 per hour plus 15% benefits) with an additional 30% overhead. Thus, the case manager intervention cost CaD $56 per patient. The 1-time cost of providing a BMD test with a physician visit was CaD $ Costs of Osteoporosis Treatment. We assumed that all treated patients received alendronate sodium, 70 mg per week, for the duration of treatment. The provincial drug plan covers generic alendronate for any elderly person who has had a hip fracture. 18 Of note, as of 2008, generic lower-cost alendronate is available in the United States. Total annual cost of medication and 1 annual physician visit related to osteoporosis evaluation and refilling of prescriptions was estimated at CaD $291 per patient. 17,18 Patients who discontinued treatment in the first year were assumed to incur the full treatment costs for that year. We assumed that alendronate would generate only trivial direct medical costs related to adverse effects. 16 Costs of Subsequent Fractures. Table 2 summarizes estimated annual costs for the health states related to treatment of subsequent hip, spine, or wrist fractures. Cost estimates were based on data relating to use of health services and unit values obtained from regional 19 or national 20 databases. Physician fees were obtained from the provincial schedule. 17 We assumed that the additional hip fracture would require surgical fixation and a 16-day hospital stay. 20 A case-mix method was used for inpatient hospital costs, based on relative resource weights and the provincial average cost per weighted case. 19 Orthopedic surgeon and internist costs were based on 1 visit each per day. It was assumed that 80% of patients were discharged to home after hip fracture and 20% to long-term care facilities; costs of long-term care were based on provincial per diems less patient 27

4 Table 3. Quality-of-Life Weights by Health State and Age a Age, y Health State Post hip fracture (initial state) Additional hip fracture Spine fracture Wrist fracture Post additional hip fracture Death a Quality-of-life weights vary between 0 (death) and 1 (perfect health) and are adapted from Zethraeus et al 11 and Ström et al. 12 copayments. 19 We considered only clinically symptomatic spine fractures in our analyses, although it is known that silent fractures contribute to morbidity and mortality. 21 Only 10% of patients with a symptomatic fracture of the spine were assumed to require inpatient care. 21 Hospital costs were estimated in a manner similar to that for hip fractures, with daily internist visits for 16 days. 20 After discharge, 9 follow-up physician visits and 1 spinal radiograph were assumed. The 90% of patients with spine fracture not hospitalized had 2 physician visits and 1 radiograph. Patients received 7 visits of outpatient rehabilitation. For wrist fractures, patients were assumed to present to an emergency department for treatment and had 1 closed fracture reduction procedure, 2 physician follow-up visits, and 1 follow-up wrist radiograph. Patients with a wrist fracture received 7 outpatient rehabilitation visits. Although a substantial minority of patients with wrist fracture require subsequent surgical fixation, we did not include this in our model. Mortality Rates. Patients were assumed to have the same risk of death as the general population, except in the year after a hip fracture. 10,11 We used published life tables for age-specific death rates. 22 Age-specific rates of death for the first year after hip fracture were derived by multiplying age-specific death rates by the excess mortality ratio derived from the International Osteoporosis Foundation cost-effectiveness reference model, 11,12 which is virtually identical to hip fracture related mortality rates from our health region. 6 Health-Related Quality of Life. The age-specific quality of life weights for each health state that we used were based on published utility weights and their proposed multipliers 11,12 (Table 3). The state with the lowest weight, other than Death, is Spine fracture after Hip fracture. Deterministic Sensitivity Analyses Conventional 1-way deterministic sensitivity analyses were conducted to evaluate the robustness of the model with respect to intervention costs (CaD $112 and CaD $168, rather than CaD $56 in the base case), treatment persistence (50%, rather than 85%), treatment costs (increased by 100%, 200%, and 500% over the base-case cost of alendronate), the fracture reduction effects of alendronate (35% vs 50%), the proportion of patients in the intervention group obtaining a BMD test (40% vs 80%), the duration of treatment (10 vs 5 years), and discount rates (0% and 5%, rather than 3%). Probabilistic Sensitivity Analysis Table 4. Costs and Health Outcomes by Intervention Status: Base Case Study Group Cost a No. of Hip Refractures To better assess the impact of covariate uncertainty, we conducted a probabilistic sensitivity analysis. Probability distributions were assigned to each of the input variables; the estimated mean values, estimated standard errors, and type of distribution for each variable are available from one of us (D.A.L.). We used a gamma distribution, with a range of 0 to infinity, to generate random values for all unit costs; otherwise a beta distribution was used for all probabilities and utilities. Parameters were defined such that the hierarchical relationship between variables was preserved, but differences between the variables were randomly selected. 23 All analyses were conducted with TreeAge Pro software (TreeAge Software Inc, Williamstown, Massachusetts). RESULTS Total No. of Refractures b PATIENT CHARACTERISTICS Study patients were elderly (median age, 74 years), 142 (65%) were women, 210 (96%) were white, and 77 (35%) reported 4 or more comorbidities. By design, none was taking osteoporosis treatment at study entry, although 82 (37%) reported a previous fracture and 58 (27%) reported a previous BMD test. Of note, of the 120 patients who had a BMD test performed, fully 27 (22%) did not have low bone mass at either the hip or the spine. INTERVENTION EFFECT QALYs c Intervention Control Difference ICER (Intervention is dominant) Abbreviations: ICER, incremental cost-effectiveness ratio; QALYs, quality-adjusted life-years. a Lifetime average costs per patient, discounted at 3%. These costs are expressed in constant 2006 Canadian dollars (multiply by 0.88 to convert to US dollars). b Includes hip, spine, and wrist refractures. c QALYs per patient, discounted at 3%. The case-manager intervention led to a rate of osteoporosis treatment of 51% compared with 22% for controls at 6 months (adjusted odds ratio, 4.7; 95% confidence interval, ). Of the 80 patients who newly started osteoporosis treatment, 68 (85% [95% confidence interval, 77%-93%]) were still having their prescriptions filled at 1 year. All patients who persisted with treatment reported greater than 80% adherence. COST-EFFECTIVENESS OF THE INTERVENTION (BASE-CASE ANALYSIS) The base-case analysis is presented in Table 4. The model suggests that, over their lifetime, patients with hip fractures exposed to our case manager intervention would be less likely to incur a fracture than controls: for every 100 patients, approximately 4 hip fractures and 6 fractures in total would be avoided. There was also an asso- 28

5 Table 5. One-Way Sensitivity Analyses Scenario No. of Hip Fractures Avoided Total No. of Fractures Avoided Incremental Costs a QALYs Gained Base case Intervention costs 100% Increase % Increase Persistence with treatment (50% rather than 85%) Alendronate sodium price 100% Increase % Increase % Increase Effect of alendronate, 30% reduction Proportion of intervention patients obtaining BMD, 50% reduction Treatment duration (10 y rather than 5 y) Discount rate (rather than 3%) 0% % Abbreviations: BMD, bone mineral density; QALYs, quality-adjusted life-years. a Costs are expressed in constant 2006 Canadian dollars (multiply by 0.88 to convert to US dollars). ciated modest increase in quality-adjusted life expectancy (0.04 quality-adjusted life-years gained per patient). Lifetime costs were also less for the intervention group than for controls, with an incremental cost saving of CaD $2576 (US $2267) per patient. Thus, the case manager strategy was dominant; it cost less and added more qualityadjusted life-years than usual care. In addition, a direct financial impact analysis suggests that, irrespective of the number of patients covered by a formal case management program, after 2 years the intervention would reach a break-even threshold, where the average third-party health care payers costs per patient would be equal for the intervention and usual-care groups. Beyond 3 years, the average cumulative cost was always lower with the intervention strategy. DETERMINISTIC SENSITIVITY ANALYSES One-way sensitivity analyses suggest that the results of the base case are robust (Table 5). In all analyses, the intervention dominated usual care even though selected factors were varied substantially. Moreover, in all scenarios the intervention achieved fewer fractures of all types per patient, and specifically fewer hip fractures, compared with usual care. Even increasing the cost of alendronate by 500% yielded eventual savings from the payer perspective. The single factor that had greatest effect on cost and effectiveness was the ability of the intervention program to provide BMD tests. When the proportion of patients in the intervention group obtaining a BMD was reduced from 80% to 40%, incremental savings dropped to CaD $544 per patient. PROBABILISTIC SENSITIVITY ANALYSIS Incremental Cost, CaD $ Incremental Effect, QALYs Gained Figure 3. Simulation results on the cost-effectiveness plane. QALYs indicates quality-adjusted life-years. Multiply by 0.88 to convert to US dollars. This analysis confirmed the economic attractiveness of the case manager intervention because 82% of the simulations we conducted resulted in dominance over usual care (Figure 3). Specifically, Figure 3 graphically illustrates that 8200 of the simulations yielded estimates for our case manager intervention that were more effective than usual care, and nearly all of the estimates in this scatterplot are below the horizontal axis, confirming that the intervention strategy is cost-saving for almost every simulation. COMMENT In a randomized controlled trial, we previously demonstrated that a hospital-based osteoporosis case manager could substantially increase the use of evidence-based osteoporosis testing and treatment when compared with usual-care controls. 2 We then conducted a formal health economic analysis alongside the trial to answer the seldom asked or answered question, Is it worthwhile? Our analysis suggests that the answer is yes. The casemanager intervention dominated usual care: for every 100 patients exposed to the intervention, a total of 6 fractures would be prevented, 4 quality-adjusted life-years would be gained, and almost CaD $ (US $ ) 29

6 would be saved by the health care system. The results were robust, and the case-manager intervention remained a dominant strategy compared with usual care over many sensitivity analyses. Furthermore, a probabilistic sensitivity analysis suggests that more than 80% of different model simulations would still yield a result where our intervention would be both more effective and cost-saving compared with usual care. This is all the more impressive because we used a modeling strategy whereby our assumptions were conservative and biased toward favoring usual care. For example, we assumed no excess mortality in patients after the first year after hip fracture and no excess mortality after spine fracture; we assumed no non fracturerelated mortality benefit in patients with hip fractures treated with bisphosphonates 3 ; we assumed no benefits associated with prevention of silent spinal fractures; we assumed no further clinical fractures after a second hip fracture; and we did not acknowledge that untreated patients with osteoporosis will continue to lose bone mass over time and have an even greater risk of future fracture. The robustness of our findings suggests that any quality improvement intervention for patients who survive a hip fracture that can achieve a rate similar to that of bisphosphonate treatment in our randomized trial (51% or more) at a similar cost (CaD $56 or less) would likely be worthwhile. Several limitations need to be taken into account when acceptance of our findings is considered. First, the trial was conducted in 220 patients and had only 12 months of follow-up. Thus, clinical event rates and utilities were derived from the literature. We did, however, adapt our model from previously published and well-validated reference models for osteoporosis Second, one-third of our trial population was male, but many inputs related to quality of life and antifracture benefit of bisphosphonates were drawn from literature based almost entirely on postmenopausal women. This is less a limitation of our analyses and more a bias in the scientific literature. Furthermore, because men have greater morbidity and mortality than women after hip fracture, 6,24 using data from women likely yields a conservative analysis that underestimates the downstream benefits of appropriate osteoporosis treatment for men. Third, we used the perspective of a third-party health care payer, examining only direct health care costs, and did not capture potential costs related to temporary incapacity, caregiver burden, or various out-of-pocket expenses or copayments. Again, it is likely that not including such costs (usually borne by patients and their families) is conservative and again tends to bias our analysis against finding the intervention economically attractive. Finally, some might be rightly concerned about generalizability. For example, we excluded nursing home patients from the trial. This vulnerable population constituted fully one-third of all patients with hip fractures treated in our region, and neither our trial nor the accompanying economic analysis can be applied to improving the quality of care for nursing home patients. Others might be concerned about applying the results of a trial and economic analysis conducted in the setting of socialized medicine to jurisdictions such as the United States. Such crossjurisdictional inferences will be more straightforward for payers and providers in other countries with universal health care coverage, such as the United Kingdom and most other members of the European Union. However, even in the United States, there are many settings where we believe our results can be directly applied, for example, in the Department of Veterans Affairs or within many large integrated delivery systems (ie, Geisinger Health Systems in Pennsylvania or Partners HealthCare in Massachusetts). At the least, for any individual hospital that takes care of patients with hip fractures, our analyses suggest that for a very small cost individual hospitals can improve the quality of evidence-based care they deliver and, after discharge, be secure in the knowledge that their patients will be better off. In conclusion, compared with usual care, we found that a pragmatic and inexpensive case-manager intervention for patients with hip fractures led to marked improvements in testing and treatment for osteoporosis. From the perspective of a third-party health care payer, the case-manager intervention dominates usual care as it is currently delivered in most jurisdictions. Our findings suggest that those who can implement a casemanager intervention similar to what we have described and reported might expect to see a reduction in osteoporosis-related fractures, a gain in life expectancy, and substantial cost savings. Accepted for Publication: May 19, Correspondence: Sumit R. Majumdar, MD, MPH, DepartmentofMedicine,UniversityofAlberta,2E3.07WalterMackenzie Health Sciences Centre, th St, Edmonton, AB T6G 2B7, Canada Author Contributions: Study concept and design: Majumdar, Lier, Hanley, Maksymowych, and Juby. Acquisition of data: Majumdar, Lier, Beaupre, and Morrish. Analysis and interpretation of data: Majumdar, Lier, Maksymowych, and Bell. Drafting of the manuscript: Majumdar and Lier. Critical revision of the manuscript for important intellectual content: Majumdar, Lier, Beaupre, Hanley, Maksymowych, Juby, Bell, and Morrish. Statistical analysis: Majumdar and Lier. Obtained funding: Majumdar and Morrish. Administrative, technical, and material support: Beaupre, Bell, and Morrish. Study supervision: Majumdar and Morrish. Financial Disclosure: Dr Hanley is on the advisory boards of Merck Frosst Canada, Proctor and Gamble Canada, Eli Lilly Canada, Novartis, and NPS Pharmaceuticals. He has participated in conducting clinical trials for Merck Frosst Canada, Proctor and Gamble Canada, Aventis, Eli Lilly Canada, Novartis, NPS Pharmaceuticals, Pfizer, Amgen, Wyeth-Ayerst, and Roche. He has received honoraria for speaking from most of these companies. Funding/Support: This study was supported by peerreviewed grants from the Health Research Fund of the Alberta Heritage Foundation for Medical Research (AHFMR) and the Royal Alexandra Hospital Foundation. Dr Majumdar receives salary support from AHFMR (Health Scholar) and the Canadian Institutes of Health Research (New Investigator). Dr Maksymowych receives salary support from AHFMR (Senior Scholar). 30

7 REFERENCES 1. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis related fractures in the United States, J Bone Miner Res. 2007;22(3): Majumdar SR, Beaupre LA, Harley CH, et al. Using a case manager to improve osteoporosis treatment after hip fracture: results of a randomized controlled trial. Arch Intern Med. 2007;167(19): Lyles KW, Colon-Emeric CS, Magaziner JS, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007;357(18): Cranney A, Guyatt GH, Griffith L, Wells G, Tugwell P, Rosen C; Osteoporosis Methodology Group and Osteoporosis Research Advisory Group. Meta-analyses of therapies for postmenopausal osteoporosis, IX: summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev. 2002;23(4): Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD. Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum. 2006;35(5): Jiang HX, Majumdar SR, Dick DA, et al. Development and initial validation of a risk score for predicting in-hospital and one-year mortality in patients with hip fractures. J Bone Miner Res. 2005;20(3): Juby AG, de Geus-Wenceslau CM. Evaluation of osteoporosis treatment in seniors after hip fracture. Osteoporos Int. 2002;13(3): Sonnenberg FA, Beck R. Markov models in medical decision-making: a practical guide. Med Decis Making. 1993;13(4): Tosteson AN, Jönsson B, Grima DT, O Brien BJ, Black DM, Adachi JD. Challenges for model-based economic evaluations of postmenopausal osteoporosis interventions. Osteoporos Int. 2001;12(10): Johnell O, Jönsson B, Jönsson L, Black D. Cost effectiveness of alendronate for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics. 2003;21(5): Zethraeus N, Borgström F, Ström O, Kanis J, Jönsson B. Cost-effectiveness of the treatment and prevention of osteoporosis a review of the literature and a reference model. Osteoporos Int. 2007;18(1): Ström O, Zethraeus N, Borgström F, Johnell O, Jönsson B, Kanis J. IOF costeffectiveness reference model: background document. International Osteoporosis Foundation. /health-economics/cost-effectiveness-model.html. Accessed May 5, Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E. Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int. 2001;12(4): Tonino RP, Meunier PJ, Emkey RD, et al. Skeletal benefits of alendronate: 7-year treatment of postmenopausal osteoporotic women. J Clin Endocrinol Metab. 2000; 85(9): Bone HG, Hosking D, Devogelaer JP, et al. Ten years experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004;350 (12): Schousboe JT, Nyman JA, Kane RL, Ensrud KE. Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med. 2005; 142(9): Alberta Health Care Insurance Plan. Schedule of Medical Benefits (Procedures and Price List). Edmonton, AB, Canada: Alberta Health and Wellness; Drug Benefits List. Edmonton, AB: Alberta Health and Wellness; Health Costing in Alberta. Annual Report. Edmonton, AB: Alberta Health and Wellness; Resource Intensity Weights and Expected Length of Stay. Ottawa, ON: Canadian Institute for Health Information; Cooper C, Atkinson EJ, O Fallon WM, Melton LJ. Incidence of clinically diagnosed vertebral fractures: a population based study in Rochester, Minnesota, J Bone Miner Res. 1992;7(2): Life Tables: Canada, Provinces and Territories, ( XIE). Ottawa, ON: Statistics Canada; Dong H, Buxton M. Early assessment of the likely cost-effectiveness of a new technology: a Markov model with probabilistic sensitivity analysis of computerassisted total knee replacement. Int J Technol Assess Health Care. 2006;22 (2): Cree MW, Juby AG, Carriere KC. Mortality and morbidity associated with osteoporosis drug treatment following hip fracture. Osteoporos Int. 2003;14(9):

The Cost-Effectiveness of Bisphosphonates in Postmenopausal Women Based on Individual Long-Term Fracture Risks

The Cost-Effectiveness of Bisphosphonates in Postmenopausal Women Based on Individual Long-Term Fracture Risks Volume ** Number ** ** VALUE IN HEALTH The Cost-Effectiveness of Bisphosphonates in Postmenopausal Women Based on Individual Long-Term Fracture Risks Tjeerd-Peter van Staa, MD, MA, PhD, 1,2 John A. Kanis,

More information

Setting The setting was secondary care. The economic study was carried out in Sweden.

Setting The setting was secondary care. The economic study was carried out in Sweden. Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden: an economic evaluation based on the MORE study Borgstrom F, Johnell O, Kanis J A, Oden A, Sykes D, Jonsson B Record Status This

More information

Clinical and economic consequences of non-adherence

Clinical and economic consequences of non-adherence Clinical and economic consequences of non-adherence Mickaël Hiligsmann Maastricht University, CAPHRI Research Institute, the Netherlands, Department of Public Health Sciences, Belgium ESPACOMP 15 th Annual

More information

Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta464

Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta464 Bisphosphonates for treating osteoporosis Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta464 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).

More information

Pharmacy Management Drug Policy

Pharmacy Management Drug Policy SUBJECT: - Forteo (teriparatide), Prolia (denosumab), Tymlos (abaloparatide) POLICY NUMBER: Pharmacy-35 EFFECTIVE DATE: 9/07 LAST REVIEW DATE: 9/29/2017 If the member s subscriber contract excludes coverage

More information

Adherence with Oral Bisphosphonate Therapy for Osteoporosis Among Patients in Canadian Clinical Practice. Not for Sale or Commercial Distribution

Adherence with Oral Bisphosphonate Therapy for Osteoporosis Among Patients in Canadian Clinical Practice. Not for Sale or Commercial Distribution Adherence with Oral Bisphosphonate Therapy for Osteoporosis Among Patients in Canadian Clinical Practice Nader Habib, MD Heather McDonald-Blumer, MD Michele Moss, MBChB, MCFP Angèle Turcotte, MD Copyright

More information

AMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT. Committee on Rheumatologic Care

AMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT. Committee on Rheumatologic Care AMERICAN COLLEGE OF RHEUMATOLOGY POSITION STATEMENT SUBJECT: PRESENTED BY: FOR DISTRIBUTION TO: Bone Mineral Density Measurement and the Role of Rheumatologists in the Management of Osteoporosis Committee

More information

Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC

Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment. William D. Leslie, MD MSc FRCPC Module 5 - Speaking of Bones Osteoporosis For Health Professionals: Fracture Risk Assessment William D. Leslie, MD MSc FRCPC Case #1 Age 53: 3 years post-menopause Has always enjoyed excellent health with

More information

Modeling the annual costs of postmenopausal prevention therapy: raloxifene, alendronate, or estrogen-progestin therapy Mullins C D, Ohsfeldt R L

Modeling the annual costs of postmenopausal prevention therapy: raloxifene, alendronate, or estrogen-progestin therapy Mullins C D, Ohsfeldt R L Modeling the annual costs of postmenopausal prevention therapy: raloxifene, alendronate, or estrogen-progestin therapy Mullins C D, Ohsfeldt R L Record Status This is a critical abstract of an economic

More information

Appendix C Best practices for post fracture osteoporosis care: Fracture Liaison Services

Appendix C Best practices for post fracture osteoporosis care: Fracture Liaison Services 1 Appendix C Best practices for post fracture osteoporosis care: Fracture Liaison Services The systematic review of models of care for the secondary prevention of osteoporotic fractures by Ganda and colleagues

More information

1.2 Health states/risk factors affected by the intervention

1.2 Health states/risk factors affected by the intervention 1.1 Definition of intervention The intervention is opportunistic screening for low bone mineral density (BMD) for women aged 70 to 90 years who present to their GP for an unrelated purpose, and subsequent

More information

O. Bruyère M. Fossi B. Zegels L. Leonori M. Hiligsmann A. Neuprez J.-Y. Reginster

O. Bruyère M. Fossi B. Zegels L. Leonori M. Hiligsmann A. Neuprez J.-Y. Reginster DOI 10.1007/s00296-012-2460-y ORIGINAL ARTICLE Comparison of the proportion of patients potentially treated with an anti-osteoporotic drug using the current criteria of the Belgian national social security

More information

NAMS Practice Pearl. Use of Drug Holidays in Women Taking Bisphosphonates. Released April 1, 2013

NAMS Practice Pearl. Use of Drug Holidays in Women Taking Bisphosphonates. Released April 1, 2013 NAMS Practice Pearl Use of Drug Holidays in Women Taking Bisphosphonates Released April 1, 2013 Dima L. Diab, MD 1, and Nelson B. Watts, MD 2 ( 1 Cincinnati VA Medical Center, Cincinnati, OH, 2 Mercy Health

More information

Health technology The study compared three strategies for diagnosing and treating obstructive sleep apnoea syndrome (OSAS).

Health technology The study compared three strategies for diagnosing and treating obstructive sleep apnoea syndrome (OSAS). Cost-effectiveness of split-night polysomnography and home studies in the evaluation of obstructive sleep apnea syndrome Deutsch P A, Simmons M S, Wallace J M Record Status This is a critical abstract

More information

Setting The setting was primary care. The economic study was carried out in the USA.

Setting The setting was primary care. The economic study was carried out in the USA. Aspirin, statins, or both drugs for the primary prevention of coronary heart disease events in men: a cost-utility analysis Pignone M, Earnshaw S, Tice J A, Pletcher M J Record Status This is a critical

More information

Controversies in Osteoporosis Management

Controversies in Osteoporosis Management Controversies in Osteoporosis Management 2018 Northwest Rheumatism Society Meeting Portland, OR April 28, 2018 Michael R. McClung, MD, FACP Director, Oregon Osteoporosis Center Portland, Oregon, USA Institute

More information

Name of Policy: Zoledronic Acid (Reclast ) Injection

Name of Policy: Zoledronic Acid (Reclast ) Injection Name of Policy: Zoledronic Acid (Reclast ) Injection Policy #: 355 Latest Review Date: May 2011 Category: Pharmacy Policy Grade: Active Policy but no longer scheduled for regular literature reviews and

More information

Men and Osteoporosis So you think that it can t happen to you

Men and Osteoporosis So you think that it can t happen to you Men and Osteoporosis So you think that it can t happen to you Jonathan D. Adachi MD, FRCPC Alliance for Better Bone Health Chair in Rheumatology Professor, Department of Medicine Michael G. DeGroote School

More information

Setting The setting was secondary care. The economic study was conducted in the USA.

Setting The setting was secondary care. The economic study was conducted in the USA. HER-2 testing and trastuzumab therapy for metastatic breast cancer: a cost-effectiveness analysis Elkin E B, Weinstein K C, Winer E P, Kuntz K M, Schnitt S J, Weeks J C Record Status This is a critical

More information

Common Drug Review Pharmacoeconomic Review Report

Common Drug Review Pharmacoeconomic Review Report Common Drug Review Pharmacoeconomic Review Report October 2015 Drug denosumab (Prolia) Indication Treatment to increase bone mass in men with osteoporosis at high risk for fracture; or who have failed

More information

A CASE STUDY OF VALUE OF INFORMATION

A CASE STUDY OF VALUE OF INFORMATION A CASE STUDY OF VALUE OF INFORMATION, Research Fellow 1/19 Background The ISPOR good practices for performance-based risk-sharing arrangements task force recommends using value of information analysis

More information

Technology appraisal guidance Published: 26 April 2017 nice.org.uk/guidance/ta442

Technology appraisal guidance Published: 26 April 2017 nice.org.uk/guidance/ta442 Ixekizumab for treating moderate to severe ere plaque psoriasis Technology appraisal guidance Published: 26 April 2017 nice.org.uk/guidance/ta442 NICE 2017. All rights reserved. Subject to Notice of rights

More information

Osteoporosis Management in Older Adults

Osteoporosis Management in Older Adults Osteoporosis Management in Older Adults Angela M Cheung, MD, PhD, FRCPC, CCD Professor of Medicine, University of Toronto Disclosures Relationship with Commercial Entities: Honoraria from: Amgen, Eli Lilly,

More information

Appendix E Health Economic modelling

Appendix E Health Economic modelling Appendix E Health Economic modelling Appendix E: Health economic modelling Page 1 of 55 1 Use of high intensity statin compared to low intensity statin in the management of FH patients 1.1 Introduction

More information

IMPROVING BONE HEALTH AND FRACTURE PREVENTION

IMPROVING BONE HEALTH AND FRACTURE PREVENTION IMPROVING BONE HEALTH AND FRACTURE PREVENTION Helen Ridley, Programme Lead, North East & North Cumbria Academic Health Science Network NORTH EAST REGION 2014/15 AHSN Single Sponsored Project Hadrian Primary

More information

Dartmouth General Hospital Fracture Liaison Service. Carla Purcell BScN, RN, CMSN(C) Fracture Navigator

Dartmouth General Hospital Fracture Liaison Service. Carla Purcell BScN, RN, CMSN(C) Fracture Navigator Dartmouth General Hospital Fracture Liaison Service Carla Purcell BScN, RN, CMSN(C) Fracture Navigator Acknowledgments Dr. Diane Theriault Heather Francis DGH Ortho Clinics Points to Cover Osteoporotic

More information

Long-term Osteoporosis Therapy What To Do After 5 Years?

Long-term Osteoporosis Therapy What To Do After 5 Years? Long-term Osteoporosis Therapy What To Do After 5 Years? Developing a Long-term Management Plan North American Menopause Society Philadelphia, PA October 11, 2017 Michael R. McClung, MD, FACP Institute

More information

Screening for Osteoporosis in Men Aged 70 Years and Older in a Primary Care Setting in the United States

Screening for Osteoporosis in Men Aged 70 Years and Older in a Primary Care Setting in the United States 478826JMHXXX10.1177/1557988313478826 American Journal of Men s HealthLim et al. Article Screening for Osteoporosis in Men Aged 70 Years and Older in a Primary Care Setting in the United States American

More information

Fragile Bones and how to recognise them. Rod Hughes Consultant physician and rheumatologist St Peter s hospital Chertsey

Fragile Bones and how to recognise them. Rod Hughes Consultant physician and rheumatologist St Peter s hospital Chertsey Fragile Bones and how to recognise them Rod Hughes Consultant physician and rheumatologist St Peter s hospital Chertsey Osteoporosis Osteoporosis is a skeletal disorder characterised by compromised bone

More information

Helicobacter pylori-associated ulcer bleeding: should we test for eradication after treatment Pohl H, Finlayson S R, Sonnenberg A, Robertson D J

Helicobacter pylori-associated ulcer bleeding: should we test for eradication after treatment Pohl H, Finlayson S R, Sonnenberg A, Robertson D J Helicobacter pylori-associated ulcer bleeding: should we test for eradication after treatment Pohl H, Finlayson S R, Sonnenberg A, Robertson D J Record Status This is a critical abstract of an economic

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Chahal HS, Marseille EA, Tice JA, et al. Cost-effectiveness of early treatment of hepatitis C virus genotype 1 by stage of liver fibrosis in a US treatment-naive population.

More information

Technology appraisal guidance Published: 4 June 2015 nice.org.uk/guidance/ta340

Technology appraisal guidance Published: 4 June 2015 nice.org.uk/guidance/ta340 Ustekinumab for treating active psoriatic arthritis Technology appraisal guidance Published: 4 June 2015 nice.org.uk/guidance/ta340 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).

More information

Direct healthcare costs of hip, vertebral, and nonhip, non-vertebral fractures.

Direct healthcare costs of hip, vertebral, and nonhip, non-vertebral fractures. Thomas Jefferson University Jefferson Digital Commons College of Population Health Faculty Papers Jefferson College of Population Health 12-1-2009 Direct healthcare costs of hip, vertebral, and nonhip,

More information

Who cares about fractures! is more important. October 3, 2014 CSIM Workshop Brian Wirzba, MD, FRCPC, FACP Clinical Professor Grey Nuns Hospital

Who cares about fractures! is more important. October 3, 2014 CSIM Workshop Brian Wirzba, MD, FRCPC, FACP Clinical Professor Grey Nuns Hospital Isn t Osteoporosis just a T Score less than 2.5?? Who cares about fractures! is more important. Why do I need to know this? October 3, 2014 CSIM Workshop Brian Wirzba, MD, FRCPC, FACP Clinical Professor

More information

Macrolides in community-acquired pneumonia and otitis media Canadian Coordinating Office for Health Technology Assessment

Macrolides in community-acquired pneumonia and otitis media Canadian Coordinating Office for Health Technology Assessment Macrolides in community-acquired pneumonia and otitis media Canadian Coordinating Office for Health Technology Assessment Record Status This is a critical abstract of an economic evaluation that meets

More information

Costing statement: Denosumab for the prevention of osteoporotic fractures in postmenopausal women

Costing statement: Denosumab for the prevention of osteoporotic fractures in postmenopausal women Costing statement: Denosumab for the prevention of osteoporotic fractures in postmenopausal women Resource impact The guidance Denosumab for the prevention of osteoporotic fractures in postmenopausal women

More information

Anabolic Therapies for Osteoporosis in Postmenopausal Women: Effectiveness and Value

Anabolic Therapies for Osteoporosis in Postmenopausal Women: Effectiveness and Value Anabolic Therapies for Osteoporosis in Postmenopausal Women: Effectiveness and Value Final Evidence Report July 17, 2017 Prepared for Note: When our process began, ICER expected FDA approval of two new

More information

Name of Policy: Boniva (Ibandronate Sodium) Infusion

Name of Policy: Boniva (Ibandronate Sodium) Infusion Name of Policy: Boniva (Ibandronate Sodium) Infusion Policy #: 266 Latest Review Date: April 2010 Category: Pharmacology Policy Grade: Active Policy but no longer scheduled for regular literature reviews

More information

Make your. first break. your last.

Make your. first break. your last. www.iofbonehealth.org Make your first break your last WHAT IS OSTEOPOROSIS? Osteoporosis is a disease in which bones become more fragile and weak, leading to an increased risk of fractures (broken bones).

More information

Fracture=Bone Attack:

Fracture=Bone Attack: Fracture=Bone Attack: Linking Hip Fractures to Osteoporosis Care Angela M. Cheung, MD, PhD, FRCPC Professor of Medicine, University of Toronto Potential Conflicts of Interests Industry Grants (to UHN)

More information

Setting The setting was primary care. The economic study was carried out in Norway.

Setting The setting was primary care. The economic study was carried out in Norway. Cost effectiveness of adding 7-valent pneumococcal conjugate (PCV-7) vaccine to the Norwegian childhood vaccination program Wisloff T, Abrahamsen T G, Bergsaker M A, Lovoll O, Moller P, Pedersen M K, Kristiansen

More information

Task Force Finding and Rationale Statement

Task Force Finding and Rationale Statement Cardiovascular Disease Prevention and Control: Reducing Out-of- Pocket Costs for Cardiovascular Disease Preventive Services for Patients with High Blood Pressure and High Cholesterol Task Force Finding

More information

FRAX, NICE and NOGG. Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield

FRAX, NICE and NOGG. Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield FRAX, NICE and NOGG Eugene McCloskey Professor of Adult Bone Diseases University of Sheffield Disclosures Research funding and/or honoraria and/or advisory boards for: o ActiveSignal, Amgen, Bayer, Boehringer

More information

Cost effectiveness of

Cost effectiveness of Cost effectiveness of brentuximab vedotin (Adcetris ) for the treatment of adult patients with relapsed or refractory CD30 positive Hodgkin Lymphoma who have failed at least one autologous stem cell transplant.

More information

Technology appraisal guidance Published: 26 October 2016 nice.org.uk/guidance/ta416

Technology appraisal guidance Published: 26 October 2016 nice.org.uk/guidance/ta416 Osimertinib for treating locally advanced or metastatic EGFR T790M mutation- positive non-small-cell lung cancer Technology appraisal guidance Published: 26 October 2016 nice.org.uk/guidance/ta416 NICE

More information

Bisphosphonate Step Therapy Criteria

Bisphosphonate Step Therapy Criteria ϯ ϯ ϯ A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Bisphosphonate Step Therapy Criteria Program may

More information

NIH Public Access Author Manuscript Endocr Pract. Author manuscript; available in PMC 2014 May 11.

NIH Public Access Author Manuscript Endocr Pract. Author manuscript; available in PMC 2014 May 11. NIH Public Access Author Manuscript Published in final edited form as: Endocr Pract. 2013 ; 19(5): 780 784. doi:10.4158/ep12416.or. FRAX Prediction Without BMD for Assessment of Osteoporotic Fracture Risk

More information

ORIGINAL INVESTIGATION

ORIGINAL INVESTIGATION ORIGINAL INVESTIGATION The Cost-effectiveness of Therapy With Teriparatide and Alendronate in Women With Severe Osteoporosis Hau Liu, MD, MBA, MPH; Kaleb Michaud, MS; Smita Nayak, MD; David B. Karpf, MD;

More information

Summary 1. Comparative effectiveness

Summary 1. Comparative effectiveness Cost-effectiveness of Sacubitril/Valsartan (Entresto) for the treatment of symptomatic chronic heart failure in adult patients with reduced ejection fraction. The NCPE has issued a recommendation regarding

More information

International Journal of Health Sciences and Research ISSN:

International Journal of Health Sciences and Research  ISSN: International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Osteoporosis- Do We Need to Think Beyond Bone Mineral Density? Dr Preeti Soni 1, Dr Shipra

More information

Parathyroid Hormone Analog for Osteoporosis Prior Authorization with Quantity Limit Criteria Program Summary

Parathyroid Hormone Analog for Osteoporosis Prior Authorization with Quantity Limit Criteria Program Summary Parathyroid Hormone Analog for Osteoporosis Prior Authorization with Quantity Limit Criteria Program Summary This prior authorization program applies to Commercial, NetResults A series, NetResults F series

More information

Bisphosphonates: a cost benefit analysis patient

Bisphosphonates: a cost benefit analysis patient Bisphosphonates: a cost benefit analysis patient Abstract Introduction: Osteoporotic hip fractures are common in elderly. There is increased risk of sustaining other fractures that incur financial burden

More information

1. Comparative effectiveness of vedolizumab

1. Comparative effectiveness of vedolizumab Cost-effectiveness of vedolizumab (Entyvio ) for the treatment of adult patients with moderately to severely active ulcerative colitis who have had an inadequate response with, lost response to, or were

More information

Cost-effectiveness of androgen suppression therapies in advanced prostate cancer Bayoumi A M, Brown A D, Garber A M

Cost-effectiveness of androgen suppression therapies in advanced prostate cancer Bayoumi A M, Brown A D, Garber A M Cost-effectiveness of androgen suppression therapies in advanced prostate cancer Bayoumi A M, Brown A D, Garber A M Record Status This is a critical abstract of an economic evaluation that meets the criteria

More information

OSTEOPOROSIS: PREVENTION AND MANAGEMENT

OSTEOPOROSIS: PREVENTION AND MANAGEMENT OSTEOPOROSIS: OVERVIEW OSTEOPOROSIS: PREVENTION AND MANAGEMENT Judith Walsh, MD, MPH Departments of Medicine and Epidemiology and Biostatistics UCSF Definitions Key Risk factors Screening and Monitoring

More information

Appendix I: Imperial College LTBI treatment report

Appendix I: Imperial College LTBI treatment report Appendix I: Imperial College LTBI treatment report 1 National Institute for Health and Care Excellence (NICE) What is the cost-effectiveness of latent tuberculosis infection (LTBI) treatment with different

More information

Technology appraisal guidance Published: 27 January 2016 nice.org.uk/guidance/ta380

Technology appraisal guidance Published: 27 January 2016 nice.org.uk/guidance/ta380 Panobinostat for treating multiple myeloma after at least 2 previous treatments Technology appraisal guidance Published: 27 January 2016 nice.org.uk/guidance/ta380 NICE 2017. All rights reserved. Subject

More information

About the National Centre for Pharmacoeconomics

About the National Centre for Pharmacoeconomics Cost effectiveness of sofosbuvir (in combination with either ribavirin or pegylated interferon + ribavirin) (Sovaldi ) for the treatment of hepatitis C infection The NCPE has issued a recommendation regarding

More information

Osteoporosis/Fracture Prevention

Osteoporosis/Fracture Prevention Osteoporosis/Fracture Prevention NATIONAL GUIDELINE SUMMARY This guideline was developed using an evidence-based methodology by the KP National Osteoporosis/Fracture Prevention Guideline Development Team

More information

Using the cost effectiveness of allogeneic islet transplantation to inform induced pluripotent stem cell-derived β-cell therapy reimbursement

Using the cost effectiveness of allogeneic islet transplantation to inform induced pluripotent stem cell-derived β-cell therapy reimbursement For reprint orders, please contact: reprints@futuremedicine.com Using the cost effectiveness of allogeneic islet transplantation to inform induced pluripotent stem cell-derived β-cell therapy reimbursement

More information

Technology appraisal guidance Published: 26 September 2012 nice.org.uk/guidance/ta264

Technology appraisal guidance Published: 26 September 2012 nice.org.uk/guidance/ta264 Alteplase for treating acute ischaemic stroke Technology appraisal guidance Published: 26 September 2012 nice.org.uk/guidance/ta264 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).

More information

ORIGINAL INVESTIGATION. Single-Site vs Multisite Bone Density Measurement for Fracture Prediction

ORIGINAL INVESTIGATION. Single-Site vs Multisite Bone Density Measurement for Fracture Prediction ORIGINAL INVESTIGATION Single-Site vs Multisite Bone Density Measurement for Fracture Prediction William D. Leslie, MD, MSc; Lisa M. Lix, PhD; James F. Tsang, BSc; Patricia A. Caetano, PhD; for the Manitoba

More information

ORIGINAL INVESTIGATION. 10-Year Probability of Recurrent Fractures Following Wrist and Other Osteoporotic Fractures in a Large Clinical Cohort

ORIGINAL INVESTIGATION. 10-Year Probability of Recurrent Fractures Following Wrist and Other Osteoporotic Fractures in a Large Clinical Cohort ORIGINAL INVESTIGATION 10-Year Probability of Recurrent Fractures Following Wrist and Other Osteoporotic Fractures in a Large Clinical Cohort An Analysis From the Manitoba Bone Density Program Anthony

More information

Research Article Prevalence of Fracture Risk Factors in Postmenopausal Women Enrolled in the POSSIBLE US Treatment Cohort

Research Article Prevalence of Fracture Risk Factors in Postmenopausal Women Enrolled in the POSSIBLE US Treatment Cohort International Journal of Endocrinology Volume 2013, Article ID 715025, 9 pages http://dx.doi.org/10.1155/2013/715025 Research Article Prevalence of Fracture Risk Factors in Postmenopausal Women Enrolled

More information

Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta466

Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta466 Baricitinib for moderate to severeere rheumatoid arthritis Technology appraisal guidance Published: 9 August 2017 nice.org.uk/guidance/ta466 NICE 2017. All rights reserved. Subject to Notice of rights

More information

Summary of Fall Prevention Initiatives in the Greater Toronto Area (GTA)

Summary of Fall Prevention Initiatives in the Greater Toronto Area (GTA) Summary of Fall Prevention Initiatives in the Greater Toronto Area (GTA) Purpose This summary serves as an accompanying document to the Inventory of Fall Prevention Initiatives in the GTA and provides

More information

Osteoporosis: A Tale of 3 Task Forces!

Osteoporosis: A Tale of 3 Task Forces! Osteoporosis: A Tale of 3 Task Forces! Robert A. Adler, MD McGuire Veterans Affairs Medical Center Virginia Commonwealth University Richmond, Virginia, USA Disclosures The opinions are those of the speaker

More information

[Correction added after online publication 22-January-2010: Reference numbering in the results section has been updated] Methods

[Correction added after online publication 22-January-2010: Reference numbering in the results section has been updated] Methods Volume 13 Number 4 2010 VALUE IN HEALTH Transferability of Model-Based Economic Evaluations: The Case of Trastuzumab for the Adjuvant Treatment of HER2-Positive Early Breast Cancer in the Netherlandsvhe_683

More information

An evaluation of the NICE guidance for the prevention of osteoporotic fragility fractures in postmenopausal women

An evaluation of the NICE guidance for the prevention of osteoporotic fragility fractures in postmenopausal women DOI 10.1007/s11657-010-0045-5 REVIEW An evaluation of the NICE guidance for the prevention of osteoporotic fragility fractures in postmenopausal women John A. Kanis & Eugene V. McCloskey & Bengt Jonsson

More information

Common Drug Review Pharmacoeconomic Review Report

Common Drug Review Pharmacoeconomic Review Report Common Drug Review Pharmacoeconomic Review Report March 2017 Drug Indication Reimbursement request Dosage form(s) Propranolol hydrochloride (Hemangiol) For the treatment of proliferating infantile hemangioma

More information

Genomic Health, Inc. Oncotype DX Colon Cancer Assay Clinical Compendium March 30, 2012

Genomic Health, Inc. Oncotype DX Colon Cancer Assay Clinical Compendium March 30, 2012 Economic Validity Eligibility and Addressability for Use of the Assay An important distinction should be made between the total population of patients eligible for the Oncotype DX Colon Cancer assay, and

More information

AACE. Orlando Drug Holidays. Disclosures. Advisory boards: Alexion, Amgen, Lilly, Merck, Radius Health

AACE. Orlando Drug Holidays. Disclosures. Advisory boards: Alexion, Amgen, Lilly, Merck, Radius Health AACE Orlando 2016 Drug Holidays Disclosures Advisory boards: Alexion, Amgen, Lilly, Merck, Radius Health Scientific grants: Alexion, Amgen, Immunodiagnostics, Lilly, Merck, Regeneron, Radius Health, Roche

More information

Purpose. Methods and Materials

Purpose. Methods and Materials Prevalence of pitfalls in previous dual energy X-ray absorptiometry (DXA) scans according to technical manuals and International Society for Clinical Densitometry. Poster No.: P-0046 Congress: ESSR 2014

More information

Appendix E Health Economic modelling

Appendix E Health Economic modelling Appendix E Health Economic modelling Page 1 of 56 1 Use of high intensity statin compared to low intensity statin in the management of FH patients 1.1 Introduction Familial hypercholesterolemia (FH) is

More information

Prevention of Osteoporotic Hip Fracture

Prevention of Osteoporotic Hip Fracture Prevention of Osteoporotic Hip Fracture Dr Law Sheung Wai 8th July 2007 Associate Consultant Spine team / Orthopedic Rehabilitation Department of Orthopedics and Traumatology NTE Cluster 1 Objectives Problems

More information

The cost-effectiveness of screening blood donors for malaria by PCR Shehata N, Kohli M, Detsky A

The cost-effectiveness of screening blood donors for malaria by PCR Shehata N, Kohli M, Detsky A The cost-effectiveness of screening blood donors for malaria by PCR Shehata N, Kohli M, Detsky A Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion

More information

Osteoporosis is estimated to develop in 1 out of 4 women over the age of 50. Influence of bone densitometry results on the treatment of osteoporosis

Osteoporosis is estimated to develop in 1 out of 4 women over the age of 50. Influence of bone densitometry results on the treatment of osteoporosis Influence of bone densitometry results on the treatment of osteoporosis Nicole S. Fitt, * Susan L. Mitchell, * Ann Cranney, Karen Gulenchyn, Max Huang, * Peter Tugwell Abstract Background: Measurement

More information

Analyses of the cost-effectiveness of pooled alendronate and risedronate, compared with strontium ranelate, raloxifene, etidronate and teriparatide

Analyses of the cost-effectiveness of pooled alendronate and risedronate, compared with strontium ranelate, raloxifene, etidronate and teriparatide Analyses of the cost-effectiveness of pooled alendronate and risedronate, compared with strontium ranelate, raloxifene, etidronate and teriparatide Dr Matt Stevenson Sarah Davis July 2006 1 Page Executive

More information

Generalised cost-effectiveness analysis for breast cancer prevention and care in Hong Kong Chinese. Wong, IOL; Tsang, JWH; Cowling, BJ; Leung, GM

Generalised cost-effectiveness analysis for breast cancer prevention and care in Hong Kong Chinese. Wong, IOL; Tsang, JWH; Cowling, BJ; Leung, GM Title Generalised cost-effectiveness analysis for breast cancer prevention and care in Hong Kong Chinese Author(s) Wong, IOL; Tsang, JWH; Cowling, BJ; Leung, GM Citation Hong Kong Medical Journal, 2015,

More information

The cost-utility of screening for depression in primary care Valenstein M, Vijan S, Zeber J E, Boehm K, Buttar A

The cost-utility of screening for depression in primary care Valenstein M, Vijan S, Zeber J E, Boehm K, Buttar A The cost-utility of screening for depression in primary care Valenstein M, Vijan S, Zeber J E, Boehm K, Buttar A Record Status This is a critical abstract of an economic evaluation that meets the criteria

More information

Health Policy 96 (2010) Contents lists available at ScienceDirect. Health Policy. journal homepage:

Health Policy 96 (2010) Contents lists available at ScienceDirect. Health Policy. journal homepage: Health Policy 96 (2010) 170 177 Contents lists available at ScienceDirect Health Policy journal homepage: www.elsevier.com/locate/healthpol The clinical and economic burden of non-adherence with oral bisphosphonates

More information

Cost-effectiveness of radiofrequency catheter ablation for atrial fibrillation Chan P S, Vijan S, Morady F, Oral H

Cost-effectiveness of radiofrequency catheter ablation for atrial fibrillation Chan P S, Vijan S, Morady F, Oral H Cost-effectiveness of radiofrequency catheter ablation for atrial fibrillation Chan P S, Vijan S, Morady F, Oral H Record Status This is a critical abstract of an economic evaluation that meets the criteria

More information

Proton therapy of cancer: potential clinical advantages and cost-effectiveness Lundkvist J, Ekman M, Ericsson S R, Jonsson B, Glimelius B

Proton therapy of cancer: potential clinical advantages and cost-effectiveness Lundkvist J, Ekman M, Ericsson S R, Jonsson B, Glimelius B Proton therapy of cancer: potential clinical advantages and cost-effectiveness Lundkvist J, Ekman M, Ericsson S R, Jonsson B, Glimelius B Record Status This is a critical abstract of an economic evaluation

More information

The Bare Bones of Osteoporosis. Wendy Rosenthal, PharmD

The Bare Bones of Osteoporosis. Wendy Rosenthal, PharmD The Bare Bones of Osteoporosis Wendy Rosenthal, PharmD Definition A systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase

More information

Improving Osteoporosis Management for Patients Who Have Had a Fracture: Can We Fix a Broken System?

Improving Osteoporosis Management for Patients Who Have Had a Fracture: Can We Fix a Broken System? Improving Osteoporosis Management for Patients Who Have Had a Fracture: Can We Fix a Broken System? Mary K. Oates, M.D., CCD Dignity Heath Arroyo Grande Community Hospital French Hospital Medical Center

More information

Setting The setting was tertiary care. The economic study was conducted in Bangkok, Thailand.

Setting The setting was tertiary care. The economic study was conducted in Bangkok, Thailand. A cost-benefit analysis of intravenous immunoglobulin treatment in children with Kawasaki disease Arj-Ong S, Lertsapcharoen P, Thisyakorn C, Chotivitayatarakorn P, Khongphatthanayothin A Record Status

More information

Drugs for Rare Disorders

Drugs for Rare Disorders Drugs for Rare Disorders A CASE FOR NATIONAL PHARMACARE THAT LEAVES NO ONE BEHIND Disclosures WIDOWER WHOSE SPOUSE DIED WITHOUT A DIAGNOSIS FATHER OF AN ADULT CHILD WITH A RARE DISORDER CO-FOUNDER & PRESIDENT,

More information

Addendum to clinical guideline 131, Colorectal cancer

Addendum to clinical guideline 131, Colorectal cancer : National Institute for Health Care Excellence Final Addendum to clinical guideline 131, Colorectal cancer Clinical guideline addendum 131.1 Methods, evidence recommendations December 2014 Final version

More information

Osteoporosis: A Tale of 3 Task Forces!

Osteoporosis: A Tale of 3 Task Forces! Osteoporosis: A Tale of 3 Task Forces! Robert A. Adler, MD McGuire Veterans Affairs Medical Center Virginia Commonwealth University Richmond, Virginia, USA Disclosures The opinions are those of the speaker

More information

Factors Associated With Pharmacologic Treatment of Osteoporosis in an Older Home Care Population

Factors Associated With Pharmacologic Treatment of Osteoporosis in an Older Home Care Population Journal of Gerontology: MEDICAL SCIENCES 2007, Vol. 62A, No. 8, 872 878 Copyright 2007 by The Gerontological Society of America Factors Associated With Pharmacologic Treatment of Osteoporosis in an Older

More information

Technology appraisal guidance Published: 28 September 2016 nice.org.uk/guidance/ta411

Technology appraisal guidance Published: 28 September 2016 nice.org.uk/guidance/ta411 Necitumumab for untreated advanced or metastatic squamous non-small-cell lung cancer Technology appraisal guidance Published: 28 September 2016 nice.org.uk/guidance/ta411 NICE 2017. All rights reserved.

More information

Cost-effectiveness of Daratumumab (Darzalex ) for the Treatment of Adult Patients with Relapsed and Refractory Multiple Myeloma.

Cost-effectiveness of Daratumumab (Darzalex ) for the Treatment of Adult Patients with Relapsed and Refractory Multiple Myeloma. Cost-effectiveness of Daratumumab (Darzalex ) for the Treatment of Adult Patients with Relapsed and Refractory Multiple Myeloma. The NCPE has issued a recommendation regarding the cost-effectiveness of

More information

NHS England Impact Analysis of implementing NHS Diabetes Prevention Programme, 2016 to 2021

NHS England Impact Analysis of implementing NHS Diabetes Prevention Programme, 2016 to 2021 NHS England Impact Analysis of implementing NHS Diabetes Prevention Programme, 2016 to 2021 1. Purpose The purpose of this document is to describe both the estimated resource implications to NHS England

More information

Background Comparative effectiveness of nivolumab

Background Comparative effectiveness of nivolumab NCPE report on the cost effectiveness of nivolumab (Opdivo ) for the treatment of locally advanced or metastatic squamous non-small cell lung cancer after prior chemotherapy in adults. The NCPE has issued

More information

Cost-Effectiveness of Switching to Exemestane after 2 to 3 Years of Therapy with Tamoxifen in Postmenopausal Women with Early-Stage Breast Cancer

Cost-Effectiveness of Switching to Exemestane after 2 to 3 Years of Therapy with Tamoxifen in Postmenopausal Women with Early-Stage Breast Cancer Volume 10 Number 5 2007 VALUE IN HEALTH Cost-Effectiveness of Switching to Exemestane after 2 to 3 Years of Therapy with Tamoxifen in Postmenopausal Women with Early-Stage Breast Cancer David Thompson,

More information

Source of effectiveness data The effectiveness data were derived from a review of completed studies and authors' assumptions.

Source of effectiveness data The effectiveness data were derived from a review of completed studies and authors' assumptions. Cost-effectiveness of hepatitis A-B vaccine versus hepatitis B vaccine for healthcare and public safety workers in the western United States Jacobs R J, Gibson G A, Meyerhoff A S Record Status This is

More information

Treatment of Osteoporosis: IHFD 6 th March 2015

Treatment of Osteoporosis: IHFD 6 th March 2015 Treatment of Osteoporosis: IHFD 6 th March 2015 Dr. John J. Carey, MB, MS, FACR, FRCPI, CCD. Consultant Physician Galway University Hospitals Associate Professor in Medicine, NUIG, Galway Vice-President

More information

EVIDENCE IN BRIEF OVERALL CLINICAL BENEFIT

EVIDENCE IN BRIEF OVERALL CLINICAL BENEFIT large impact on cost-effectiveness. perc discussed that one of the main factors affecting the costeffectiveness estimates was the survival estimates used in the economic model. In reviewing the clinical

More information

Exploring uncertainty in cost effectiveness analysis. Francis Ruiz NICE International (acknowledgements to: Benjarin Santatiwongchai of HITAP)

Exploring uncertainty in cost effectiveness analysis. Francis Ruiz NICE International (acknowledgements to: Benjarin Santatiwongchai of HITAP) Exploring uncertainty in cost effectiveness analysis Francis Ruiz NICE International (acknowledgements to: Benjarin Santatiwongchai of HITAP) NICE International and HITAP copyright 2013 Why uncertainty

More information