Osteoporosis

Osteoporosis is a systemic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue with a subsequent increase in bone fragility and susceptibility to fracture. The most serious clinical consequences of osteoporosis are hip fractures that increase in incidence exponentially with age and incur high morbidity, mortality and health care expenditure. Other common osteoporotic fractures occur at the spine, forearm, and shoulder. (See Consensus development conference (1991). Diagnosis, prophylaxis and treatment of osteoporosis. American Journal of Medicine 90: 107-110.)

In the UK, the recent establishment of the National Institute for Clinical Excellence (NICE) reflects the Government´s commitment to investigating cost-effectiveness alongside clinical effectiveness for drugs and other interventions, in order to make efficient use of scarce health care resources. Many agents of widely different efficacy and cost are now available for the treatment of osteoporosis with an estimated £1030 million spent annually in the UK in treating osteoporotic fractures in women aged 50 years or over.1

ScHARR developed an individual patient based model2 that used a statistical technique novel to health economic evaluations.3 This modelling structure allowed the patient history to influence future probability of fracture, that could not be easily attained within a standard transition-state cohort approach.

This model has been utilised in work for both the National Institute for Clinical Excellence (NICE) and the National Co-ordinating Centre for Health Technology Assessment in assessing the cost-effectiveness of pharmaceutical treatments for osteoporosis.4-6 In 2005 ScHARR have been commissioned by NICE to evaluate the cost-effectiveness of prevention strategies to treat the asymptomatic, and to evaluate the cost-effectiveness of strontium ranelate. ScHARR are also heavily involved in the NICE Guidelines Development Group for osteoporosis.

Publications

  1. Dolan P, Torgerson DJ (1998). The cost of treating osteoporotic fractures in the United Kingdom female population ,Osteoporosis International 8: 611-617
  2. Stevenson MD, Brazier JE, Calvert NW, Lloyd-Jones M, Oakley J, Kanis JA. Description of an individual patient methodology for calculating the cost-effectiveness of treatments for osteoporosis in women. Journal of Operational Research Society 56 (2005) 214-221.
  3. Stevenson MD, Oakley J, Chilcott JB. Gaussian process modelling in conjunction with individual patient simulation modelling. A case study describing the calculation of cost-effectiveness ratios for the treatment of osteoporosis. Medical Decision Making 24 (2004) 89-100.
  4. Kanis JA, Brazier J, Stevenson M, Lloyd-Jones M, Calvert NW, Treatment of Established Osteoporosis. Health Technology Assessment 2002 (6) No 29. pp 1 –1 46.
  5. Stevenson MD et al. A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. .Health Technology Assessment , 2005, 9(22).
  6. Kanis JA, Brazier J, Stevenson M, McCloskey EV, Lloyd-Jones M, Davis S. Glucocorticosteroid Induced Osteoporosis: A systematic review and cost-utility analysis. In Press