In the United States there is a rapid growth of the elderly and they are at risk of osteoporosis and fracture. The number of fractures observed each year is also increasing (J Bone Miner Res 22: 465-475). For these three causes cost-effectiveness considerations are warrant and the aim of this study is to identify the level of absolute fracture risk at which treatment intervention becomes cost-effective. A Markov cohort model (Med Decis Mak 13:322-338) of annual United States age specific incidence of clinical hip, spine, forearm, shoulder, rib, pelvis and lower leg fractures, costs represented in 2005 United States dollars (Osteoporos Int 13:323-330), quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment (600$/yr drug cost for 5 years with 35% fracture reduction) by gender and race/ethnicity groups. To determine the 10-year hip fracture probability at which treatment became cost-effective, average annual age-specific probabilities for all fractures were multiplied by relative risk (Osteoporos Int DOI 10.1007/s00198-008-0559-5). At each age, the cost per QALY gained for individuals of average age-specific risk were two or more times greater for black, Asian and Hispanic women and white men than those estimated for white women. For black, Asian and Hispanic men the cost per QALY gained was two or more times greater than those estimated for white men. The intervention thresholds are slightly higher for men compared with women. The authors have demonstrated that osteoporosis treatment is cost-effective when the 10-year hip fracture probability reached approximately 3% and that the application of the WHO risk prediction algorithm may facilitate efficient osteoporosis treatment.

Posted by: Alberto Lombardi, Fondazione Giovanni Lorenzini (Milan – Houston)

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