Cost-Effectiveness of Alendronate in the Treatment of Osteoporosis in Denmark - An Economic Evaluation Based on the Fracture Intervention Trial

Background: The Fracture Intervention Trial (FIT) showed that the bisphosphonate alendronate reduces the risk of fractures in women with low bone mass in the United States. Objective: To estimate the cost-effectiveness (cost per life-year gained and cost per quality-adjusted life-year, QALY, gained) of treating osteoporotic women in Denmark with alendronate, compared with no treatment. Design: A Markov model earlier used in the economic evaluation for Sweden was adapted using epidemiological and cost data for Denmark. In the base-case alendronate was assumed to have a fracture-risk reducing effect for ten years; a treatment duration period of 5 years followed by a 5-year period where the effect declined linearly to zero. Results: Treating a 71-year old (the mean age in the vertebral arm of the FIT) osteoporotic woman with one prior vertebral fracture with alendronate was found to be associated with a cost of DKK 52,311 per QALY gained. The cost-effectiveness ratio when treating a 69-year old woman with low bone mass and without previous vertebral fractures was higher (DKK 205,816) but still within the limits of what can be considered good value for money. Conclusions: The results of this study indicate that treatment with alendronate in Denmark is cost-effective, provided the treatment is targeted towards high-risk patients corresponding to the patient groups in the FIT study.osteoporosis; cost-effectiveness; quality of life; Markov models; acceptability curve

A reassessment of the cost-effectiveness of hormone replacement therapy in Sweden – results based on the Women’s Health Initiative randomised controlled trial

The cost-effectiveness of hormone replacement therapy (HRT) based on a societal perspective is reassessed based on new medical evidence found in the Women’s Health Initiative (WHI). Within a model framework using an individual state transition model the cost-effectiveness of 50-60 year old women with menopausal symptoms is assessed in Sweden. The Markov model has a 50 year time horizon divided into a cycle length of 1 year. The model consists of the following disease states: Coronary Heart Disease (CHD), Stroke, Venous thromboembolic events, breast cancer, colorectal cancer, hip fracture, vertebral fracture and wrist fracture. An intervention is modelled by its impact on the disease risks during and after the cessation of therapy. The model calculates costs and quality adjusted life years (QALYs) with and without intervention. The resulting cost per gained QALY is compared to the value of a gained QALY, which is set to SEK 600 000. The model requires data on clinical effects, risks, mortality rates, quality of life weights and costs valid for Sweden. The cost-effectiveness ratios are estimated at about SEK 10 000, which is far below the value of a gained QALY. Conditional on that HRT increases the quality of life weight more than 0.013 the therapy is cost-effective. In conclusion, given the new evidence in WHI, there is still a high probability that HRT is a cost-effective strategy for women with menopausal symptoms.cost-effectiveness analysis; hormone replacement therapy; Markov model

Costs and quality of life associated with osteoporosis related fractures - Results from a Swedish survey

There are few studies investigating the consequences of osteoporotic (low bone density) fractures in terms of costs and health outcomes. The purpose of this Swedish pilot study is to assess the costs and quality of life related to fractures of the hip, spine, wrist and shoulder and further to identify important cost items that should be included in future studies in this area. Data were collected using a questionnaire administered by a nurse at Malmö University Hospital. The costs are collected based on a societal perspective and include both direct and indirect costs. Health effects were measured by the EuroQol questionnaire, rating scale method and the SF-36. The total costs varied between SEK 23 000 for a wrist fracture and SEK 63 000 for a hip fracture. Although that the response rate is low the cost and quality of life related to hip fracture are close to the results presented in other studies. The major new finding is that spine fractures are associated with higher costs and lower quality of life than previously assumed. Future studies must include a sufficient number of patients in order to obtain reliable cost and health effect estimates after osteoporotic fractures in general and after spine fractures in particular. Such studies will provide important inputs for health economic evaluations assessing the cost-effectiveness of the treatment and prevention of osteoporosis.costs; fracture; osteoporosis; quality of life

Cost effectiveness of disc prosthesis versus lumbar fusion in patients with chronic low back pain: randomized controlled trial with 2-year follow-up

This randomized controlled health economic study assesses the cost-effectiveness of the concept of total disc replacement (TDR) (Charité/Prodisc/Maverick) when compared with the concept of instrumented lumbar fusion (FUS) [posterior lumbar fusion (PLF) /posterior lumbar interbody fusion (PLIF)]. Social and healthcare perspectives after 2 years are reported. In all, 152 patients were randomized to either TDR (n = 80) or lumbar FUS (n = 72). Cost to society (total mean cost/patient, Swedish kronor = SEK, standard deviation) for TDR was SEK 599,560 (400,272), and for lumbar FUS SEK 685,919 (422,903) (ns). The difference was not significant: SEK 86,359 (−45,605 to 214,332). TDR was significantly less costly from a healthcare perspective, SEK 22,996 (1,202 to 43,055). Number of days on sick leave among those who returned to work was 185 (146) in the TDR group, and 252 (189) in the FUS group (ns). Using EQ-5D, the total gain in quality adjusted life years (QALYs) over 2 years was 0.41 units for TDR and 0.40 units for FUS (ns). Based on EQ-5D, the incremental cost-effectiveness ratio (ICER) of using TDR instead of FUS was difficult to analyze due to the “non-difference” in treatment outcome, which is why cost/QALY was not meaningful to define. Using cost-effectiveness probabilistic analysis, the net benefit (with CI) was found to be SEK 91,359 (−73,643 to 249,114) (ns). We used the currency of 2006 where 1 EURO = 9.26 SEK and 1 USD = 7.38 SEK. It was not possible to state whether TDR or FUS is more cost-effective after 2 years. Since disc replacement and lumbar fusion are based on different conceptual approaches, it is important to follow these results over time

Accelerering av FreeRTOS medSierra RTOS accelerator : Implementering av ett FreeRTOS mjukvarulagerpå Sierra RTOS accelerator

Today, the effect of the most common ways to improve the performance of embedded systems and real-time operating systems is stagnating. Therefore it is interesting to examine new ways to push the performance boundaries of embedded systems and real-time operating systems even further. It has previously been demonstrated that the hardware-based real-time operating system, Sierra, has better performance than the software-based real-time operating system, FreeRTOS. These real-time operating systems have also been shown to be similar in many aspects, which mean that it is possible for Sierra to accelerate FreeRTOS. In this thesis an implementation of such acceleration has been carried out. Because existing real-time operating systems are constantly in development combined with that it was several years since an earlier comparison between the two real-time operating systems was per-formed, FreeRTOS and Sierra were compared in terms of functionality and architecture also in this thesis. This comparison showed that FreeRTOS and Sierra share the most fundamental functions of a real-time operating system, and thus can be accelerated by Sierra, but that FreeRTOS also has a number of exclusive functions to facilitate the use of that real-time operating system. The infor-mation obtained by this comparison was the very essence of how the acceleration would be imple-mented. After a number of performance tests it could be concluded that all of the implemented functions, with the exception of a few, had shorter execution time than the corresponding functions in the original version of FreeRTOS.Idag är effekten av de vanligaste åtgärderna för att förbättra prestandan av inbyggda system och realtidsoperativsystem väldigt liten. På grund av detta är det intressant att undersöka nya åtgärder för att tänja prestandagränserna av inbyggda system och realtidsoperativsystem ytterliggare. Det har tidigare påvisats att det hårdvarubaseraderealtidsoperativsystemet, Sierra, har bättre prestanda än det mjukvarubaseraderealtidsoperativsystemet, FreeRTOS. Dessa realtidsoperativsystem har även visats vara lika i flera aspekter, vilket betyder att det är möjligt för Sierra att accelererera FreeRTOS. I detta examensarbete har en implementering av en sådan acceleration genomförts. Eftersom befintliga realtidsoperativsystem ständigtär i utveckling i kombination med att det är flera år sedan som en tidigare jämförelse mellan de båda systemen utfördes, så jämfördes FreeRTOS och Sierra i fråga om funktionalitet och uppbyggnad även i detta examensarbete.Denna jämförelse visade att FreeRTOS och Sierra delar de mest grundläggande funktionerna av ett realtidsoperativsystem, och som därmed kan accelereras av Sierra, men att FreeRTOS även har ett antal exklusiva funktioner för att underlätta användningen av det realtidsoperativsystemet. Informationen som erhölls av denna jämförelse var sedan grunden för hur själva accelerationen skulle implementeras. Efter ett antal prestandatesterkunde det konstateras att alla implementerade funktioner, med undantag för ett fåtal, hade kortare exekveringstid än motsvarande funktioner i ursprungsversionen av FreeRTOS

Accelerering av FreeRTOS medSierra RTOS accelerator : Implementering av ett FreeRTOS mjukvarulagerpå Sierra RTOS accelerator

Today, the effect of the most common ways to improve the performance of embedded systems and real-time operating systems is stagnating. Therefore it is interesting to examine new ways to push the performance boundaries of embedded systems and real-time operating systems even further. It has previously been demonstrated that the hardware-based real-time operating system, Sierra, has better performance than the software-based real-time operating system, FreeRTOS. These real-time operating systems have also been shown to be similar in many aspects, which mean that it is possible for Sierra to accelerate FreeRTOS. In this thesis an implementation of such acceleration has been carried out. Because existing real-time operating systems are constantly in development combined with that it was several years since an earlier comparison between the two real-time operating systems was per-formed, FreeRTOS and Sierra were compared in terms of functionality and architecture also in this thesis. This comparison showed that FreeRTOS and Sierra share the most fundamental functions of a real-time operating system, and thus can be accelerated by Sierra, but that FreeRTOS also has a number of exclusive functions to facilitate the use of that real-time operating system. The infor-mation obtained by this comparison was the very essence of how the acceleration would be imple-mented. After a number of performance tests it could be concluded that all of the implemented functions, with the exception of a few, had shorter execution time than the corresponding functions in the original version of FreeRTOS.Idag är effekten av de vanligaste åtgärderna för att förbättra prestandan av inbyggda system och realtidsoperativsystem väldigt liten. På grund av detta är det intressant att undersöka nya åtgärder för att tänja prestandagränserna av inbyggda system och realtidsoperativsystem ytterliggare. Det har tidigare påvisats att det hårdvarubaseraderealtidsoperativsystemet, Sierra, har bättre prestanda än det mjukvarubaseraderealtidsoperativsystemet, FreeRTOS. Dessa realtidsoperativsystem har även visats vara lika i flera aspekter, vilket betyder att det är möjligt för Sierra att accelererera FreeRTOS. I detta examensarbete har en implementering av en sådan acceleration genomförts. Eftersom befintliga realtidsoperativsystem ständigtär i utveckling i kombination med att det är flera år sedan som en tidigare jämförelse mellan de båda systemen utfördes, så jämfördes FreeRTOS och Sierra i fråga om funktionalitet och uppbyggnad även i detta examensarbete.Denna jämförelse visade att FreeRTOS och Sierra delar de mest grundläggande funktionerna av ett realtidsoperativsystem, och som därmed kan accelereras av Sierra, men att FreeRTOS även har ett antal exklusiva funktioner för att underlätta användningen av det realtidsoperativsystemet. Informationen som erhölls av denna jämförelse var sedan grunden för hur själva accelerationen skulle implementeras. Efter ett antal prestandatesterkunde det konstateras att alla implementerade funktioner, med undantag för ett fåtal, hade kortare exekveringstid än motsvarande funktioner i ursprungsversionen av FreeRTOS

Health economics of osteoporosis

Health economics is concerned about how the scarce resources should most efficiently be allocated to maximise the health outcomes. Health economic evaluation is a method for assessing costs and benefits of alternative treatment strategies for allocating resources to assist decisions aiming at improving efficiency. Osteoporosis is a systemic skeletal disease characterised by low bone mass and micro architectural deterioration of bone tissue leading to increased bone fragility and thus an increased risk of fractures. Fractures are a burden to society, with respect to mortality, costs as well as quality of life. There are several treatments available for the prevention and treatment of osteoporosis. The general purpose of this thesis was to develop important aspects of the health economics of osteoporosis. More specifically, the aspects addressed were fracture related costs and quality of life for use in economic evaluation, economic modelling of osteoporosis therapies and health economics as a tool in treatment guidelines and patient selection (intervention thresholds). Data concerning costs and quality of life related to osteoporotic fractures in Sweden was collected in a prospective study that followed hip, vertebral and wrist fracture patients 18 months after fracture. The results for the first year after fracture indicate that hip fracture is associated with the highest costs whereas vertebral fracture leads to the largest loss in quality of life of the three types of fracture. Using computer simulation models the cost-effectiveness was assessed for two drugs: raloxifene and strontium ranelate. The cost-effectiveness of raloxifene compared to no treatment was estimated on Swedish women who were similar in characteristics to the women included in the Multiple Outcomes of Raloxifene study. The study was based on Swedish women who were similar in characteristics to the patients in the Spinal Osteoporosis Therapeutic Intervention study (SOTI) and Treatment Of Peripheral Osteoporosis Study (TROPOS). Compared to no treatment, both drugs were indicated to be cost-effective treatments. Intervention thresholds for osteoporosis can be defined as the ten-year risk of hip fracture at which intervention becomes cost-effective. Based on a Markov cohort model intervention thresholds were estimated for seven countries. The ten-year risk of hip fracture at which treatment becomes cost-effective varied between countries mainly due to differences in the willingness to pay (WTP) for a QALY gained, fracture related costs and intervention costs. Economic evaluation has become an important tool for evaluating the value for money of new medical technologies. However, much of the quality of an economic evaluation relies on the quality of the data used in the analysis. Using a new framework for collecting data on fracture related costs and quality of life this thesis has provided new information on costs and quality of life for fractures in Sweden, which will improve future economic evaluations of osteoporosis therapies. Moreover, this demonstrates that economic evaluation can be a tool for improving the selection of patients in clinical practice who are suitable for treatment, based on a cost-effectiveness criterion