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

Predicting survival in cost-effectiveness analyses based on clinical trials

This paper deals with the question how to model health effects after the cessation of a randomised controlled trial (RCT). Using clinical trial data on severe congestive heart failure patients we illustrate how survival beyond the cessation of a RCT can be predicted based on parametric survival models. In the analysis we compare the predicted survival and the resulting incremental cost-effectiveness ratio (ICER) of different survival models with the actual survival/ICER. Our main finding is that the results are highly sensitive to the choice of survival model and that extensive sensitivity analysis in the CE analysis is required. We also show that adding the true survival after the end of the clinical study will underestimate the true variability

Cost-effectiveness of alendronate in the treatment of osteoporois 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

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

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

Health-care cost reduction resulting from primary-care allergy testing in children in Italy

<p>Abstract</p> <p>Background</p> <p>Allergy places a considerable cost burden on society. Specific immunoglobulin E (spIgE) testing may improve the management of allergy patients. There is therefore a reason to quantify the economic consequences of the use of spIgE testing in the diagnosis of allergic conditions.</p> <p>Methods</p> <p>The expected costs of spIgE testing versus no-testing were calculated using a clinical decision model based on a prospective clinical trial performed in primary care.</p> <p>Results</p> <p>The expected costs per patient over 2 years decreased from 802 euros in the "no-test strategy" to 560 euros in the spIgE "test strategy". Cost savings persisted even after assumptions about the prevalence of allergy and the prices of medications were changed. The "test strategy" increased the percentage of patients correctly diagnosed from 54 to 87%.</p> <p>Conclusions</p> <p>spIgE testing of children with respiratory and/or skin problems in primary care in Italy reduces overall costs to society. These cost savings mostly result from a reduction in the use of medications, particularly corticosteroids. The study indicates that spIgE testing of all children with respiratory and/or skin symptoms would be a cost-effective strategy.</p

Physiological Correlates of Volunteering

We review research on physiological correlates of volunteering, a neglected but promising research field. Some of these correlates seem to be causal factors influencing volunteering. Volunteers tend to have better physical health, both self-reported and expert-assessed, better mental health, and perform better on cognitive tasks. Research thus far has rarely examined neurological, neurochemical, hormonal, and genetic correlates of volunteering to any significant extent, especially controlling for other factors as potential confounds. Evolutionary theory and behavioral genetic research suggest the importance of such physiological factors in humans. Basically, many aspects of social relationships and social activities have effects on health (e.g., Newman and Roberts 2013; Uchino 2004), as the widely used biopsychosocial (BPS) model suggests (Institute of Medicine 2001). Studies of formal volunteering (FV), charitable giving, and altruistic behavior suggest that physiological characteristics are related to volunteering, including specific genes (such as oxytocin receptor [OXTR] genes, Arginine vasopressin receptor [AVPR] genes, dopamine D4 receptor [DRD4] genes, and 5-HTTLPR). We recommend that future research on physiological factors be extended to non-Western populations, focusing specifically on volunteering, and differentiating between different forms and types of volunteering and civic participation