Cost-Effectiveness of Preventing Hip Fracture in the General Female Population |
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Authors: | J A Kanis A Dawson A Oden O Johnell C de Laet B Jonsson |
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Institution: | (1) Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, Sheffield, UK, GB;(2) Lilly Research Centre, Windlesham, Surrey, UK, GB;(3) Solberg 8414, S-442 92 Romelanda, Sweden, SE;(4) Department of Orthopaedics, Malmo¨ General Hospital, Sweden, SE;(5) Institute for Medical Technology Assessment, The Netherlands;, NL;(6) Department of Economics, Stockholm School of Economics, Stockholm, Sweden, SE |
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Abstract: | The aims of this study were to determine whether treatments that reduce the incidence of hip fracture might be used in the
general female population rather than screening or case-finding strategies. Cost-effectiveness, measured as cost per quality-adjusted
life-year (QALY) gained using threshold values for cost-effectiveness of $20.000 or $30.000/QALY gained, was assessed during
and after treatment using a computer simulation model applied to the female population of Sweden. The base case assumed a
5-year intervention that reduced the risk of hip fracture by 35% during the treatment period, and an effect that reversed
to the pretreatment risk during the next 5 years. Sensitivity analyses included the effects of age, different treatment costs
and effectiveness. Cost-effectiveness was critically dependent upon the age and costs of intervention. Reasonable cost-effectiveness
was shown even with relatively high intervention costs for women at average risk at the age of 84 years or more. For the cheapest
interventions ($63/year) cost-effectiveness could be found from the age of 53 years. Variations in effectiveness (15–50% risk
reduction) had marked effects on the age that treatment was worthwhile. We conclude that segments of the apparently healthy
population could be advantaged by treatment if efficacy were supported by randomized controlled studies.
Received: May 2000 / Accepted: November 2000 |
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Keywords: | :Cost-effectiveness – Global strategy – Hip fracture – Screening |
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