The decrement in utility associated with fractures is the cumulative loss of utility over time. There is, at present, little international consensus as to when treatment can be considered to be cost-effective [277–279]. One approach is to base the threshold value on a measure of a country’s economic performance, and a value of about
two times the GDP/capita has been suggested as a threshold that can be applied to Western economies [280]. On this basis, threshold values would be about €32,000 in the UK, close to the recommendation of the National Institute for Health and Clinical Excellence [50, 51]. Gefitinib mw Although the GDP per capita provides an index of affordability, there is also a marked heterogeneity in the proportion of GDP that countries are willing to devote
to health care and in the proportion of the population at risk from osteoporotic fracture (i.e. elderly people). These factors will also affect what is an acceptable price to pay which need to be defined on a country by country basis [8]. Studies of intervention There has been a rapid expansion of research on the cost-utility of interventions in osteoporosis which has been the subject of several reviews [50, 51, 118, 174, 281–283]. Despite the use of different models, different settings and payer perspectives, analyses suggest that there are YAP-TEAD Inhibitor 1 molecular weight cost-effective scenarios that can be found in the context of the management of osteoporosis for all but the most expensive interventions (Table 14). A pan-European study from 2004 estimated the cost-effectiveness of branded alendronate in nine countries [284]. In this study,
alendronate was shown to be cost saving compared to no treatment in women with osteoporosis (with and without previous vertebral fracture) from the Nordic countries (Norway, Sweden and Denmark). The cost-effectiveness of alendronate compared to no treatment was also within acceptable ranges in Belgium, France, Germany, Italy, Spain, Switzerland and the UK. However, with the decreased price of generic alendronate, analyses based on a branded drug price have become obsolete and would require an update. Table 14 Comparison of the cost-effectiveness of alendronate next with other interventions in women aged 70 years from the UK (data for treatments other than alendronate from [122], with permission from Elsevier) Intervention T-score = −2.5 SD No BMD No prior fracture Prior fracture Prior fracture Alendronate 6,225 4,727 6,294 Etidronate 12,869 10,098 9,093 Ibandronate daily 20,956 14,617 14,694 Ibandronate intermittent 31,154 21,587 21,745 Raloxifene 11,184 10,379 10,808 Raloxifene without breast cancer 34,011 23,544 23,755 Risedronate 18,271 12,659 13,853 Strontium ranelate 25,677 18,332 19,221 Strontium ranelate, post hoc analysis 18,628 13,077 13,673 The advent of probability-based assessment has prompted the cost-effectiveness of interventions as a function of fracture probability.