1
|
Li N, Beaudart C, Cauley JA, Ing SW, Lane NE, Reginster JY, Silverman S, Singer AJ, Hiligsmann M. Cost Effectiveness Analyses of Interventions for Osteoporosis in Men: A Systematic Literature Review. PHARMACOECONOMICS 2023; 41:363-391. [PMID: 36738425 PMCID: PMC10020287 DOI: 10.1007/s40273-022-01239-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND Osteoporosis is often considered to be a disease of women. Over the last few years, owing to the increasing clinical and economic burden, the awareness and imperative for identifying and managing osteoporosis in men have increased substantially. With the approval of agents to treat men with osteoporosis, more economic evaluations have been conducted to assess the potential economic benefits of these interventions. Despite this concern, there is no specific overview of cost-effectiveness analyses for the treatment of osteoporosis in men. OBJECTIVES This study aims (1) to systematically review economic evaluations of interventions for osteoporosis in men; (2) to critically appraise the quality of included studies and the source of model input data; and (3) to investigate the comparability of results for studies including both men and women. METHODS A literature search mainly using MEDLINE (via Ovid) and Embase databases was undertaken to identify original articles published between 1 January, 2000 and 30 June, 2022. Studies that assessed the cost effectiveness of interventions for osteoporosis in men were included. The Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases and the International Osteoporosis Foundation osteoporosis-specific guideline was used to assess the quality of design, conduct, and reporting of included studies. RESULTS Of 2973 articles identified, 25 studies fulfilled the inclusion criteria, classified into economic evaluations of active drugs (n = 8) or nutritional supplements (n = 4), intervention thresholds (n = 5), screening strategies (n = 6), and post-fracture care programs (n = 2). Most studies were conducted in European countries (n = 15), followed by North America (n = 9). Bisphosphonates (namely alendronate) and nutritional supplements were shown to be generally cost effective compared with no treatment in men over 60 years of age with osteoporosis or prior fractures. Two other studies suggested that denosumab was cost effective in men aged 75 years and older with osteoporosis compared with bisphosphates and teriparatide. Intervention thresholds at which bisphosphonates were found to be cost effective varied among studies with a 10-year probability of a major osteoporotic fracture that ranged from 8.9 to 34.2% for different age categories. A few studies suggested cost effectiveness of screening strategies and post-fracture care programs in men. Similar findings regarding the cost effectiveness of drugs and intervention thresholds in women and men were captured, with slightly greater incremental cost-effectiveness ratios in men. The quality of the studies included had an average score of 18.8 out of 25 (range 13-23.5). Hip fracture incidence and mortality risk were mainly derived from studies in men, while fracture cost, treatment efficacy, and disutility were commonly derived from studies in women or studies combining both sexes. CONCLUSIONS Anti-osteoporosis drugs and nutritional supplements are generally cost effective in men with osteoporosis. Screening strategies and post-fracture care programs also showed economic benefits for men. Cost-effectiveness and intervention thresholds were generally similar in studies conducted in both men and women, with slightly greater incremental cost-effectiveness ratios in men.
Collapse
Affiliation(s)
- Nannan Li
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Charlotte Beaudart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven W Ing
- Division of Endocrinology, Diabetes and Metabolism, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nancy E Lane
- Department of Medicine, University of California at Davis, School of Medicine, Sacramento, CA, USA
| | - Jean-Yves Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Stuart Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrea J Singer
- Departments of Obstetrics and Gynecology and Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| |
Collapse
|
2
|
Daggett SM, Cantarelli T, Gyftopoulos S, Krueger P, Ross AB. Cost-effectiveness Analysis in Diagnostic Musculoskeletal Radiology: A Systematic Review. Curr Probl Diagn Radiol 2022; 52:20-24. [DOI: 10.1067/j.cpradiol.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022]
|
3
|
Pisu M, Kopperdahl DL, Lewis CE, Saag KG, Keaveny TM. Cost-Effectiveness of Osteoporosis Screening Using Biomechanical Computed Tomography for Patients With a Previous Abdominal CT. J Bone Miner Res 2019; 34:1229-1239. [PMID: 30779860 PMCID: PMC6687393 DOI: 10.1002/jbmr.3700] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/22/2019] [Accepted: 02/10/2019] [Indexed: 12/11/2022]
Abstract
Osteoporosis screening rates by DXA are low (9.5% women, 1.7% men) in the US Medicare population aged 65 years and older. Addressing this care gap, we estimated the benefits of a validated osteoporosis diagnostic test suitable for patients age 65 years and older with an abdominal computed tomography (CT) scan taken for any indication but without a recent DXA. Our analysis assessed a hypothetical cohort of 1000 such patients in a given year, and followed them for 5 years. Separately for each sex, we used Markov modeling to compare two mutually exclusive scenarios: (i) utilizing the CT scans, perform one-time "biomechanical computed tomography" (BCT) analysis to identify high-risk patients on the basis of both femoral strength and hip BMD T-scores; (ii) ignore the CT scan, and rely instead on usual care, consisting of future annual DXA screening at typical Medicare rates. For patients with findings indicative of osteoporosis, 50% underwent 2 years of treatment with alendronate. We found that BCT provided greater clinical benefit at lower cost for both sexes than usual care. In our base case, compared to usual care, BCT prevented hip fractures over a 5-year window (3.1 per 1000 women; 1.9 per 1000 men) and increased quality-adjusted life years (2.95 per 1000 women; 1.48 per 1000 men). Efficacy and savings increased further for higher-risk patient pools, greater treatment adherence, and longer treatment duration. When the sensitivity and specificity of BCT were set to those for DXA, the prevented hip fractures versus usual care remained high (2.7 per 1000 women; 1.5 per 1000 men), indicating the importance of high screening rates on clinical efficacy. Therefore, for patients with a previously taken abdominal CT and without a recent DXA, osteoporosis screening using biomechanical computed tomography may be a cost-effective alternative to current usual care. © 2019 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, AL, USA
| | | | - Cora E Lewis
- Department of Epidemiology, University of Alabama Birmingham, Birmingham, AL, USA
| | - Kenneth G Saag
- Division of Clinical Immunology and Rheumatolog, University of Alabama Birmingham, Birmingham, AL, USA
| | - Tony M Keaveny
- Departments of Mechanical Engineering and Bioengineering, University of California Berkeley, Berkeley, CA, USA
| |
Collapse
|
4
|
Affiliation(s)
- Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
5
|
Diem SJ, Peters KW, Gourlay ML, Schousboe JT, Taylor BC, Orwoll ES, Cauley JA, Langsetmo L, Crandall CJ, Ensrud KE. Screening for Osteoporosis in Older Men: Operating Characteristics of Proposed Strategies for Selecting Men for BMD Testing. J Gen Intern Med 2017; 32:1235-1241. [PMID: 28815485 PMCID: PMC5653561 DOI: 10.1007/s11606-017-4153-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/27/2017] [Accepted: 07/27/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND The optimal approach for selecting men for bone mineral density (BMD) testing to screen for osteoporosis is uncertain. OBJECTIVE To compare strategies for selecting older men for screening BMD testing. DESIGN Prospective cohort study. PARTICIPANTS A total of 4043 community-dwelling men aged ≥70 years at four US sites. MAIN MEASURES BMD at the total hip, femoral neck, and lumbar spine using dual-energy x-ray absorptiometry (DXA). Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating curve (AUC) of the Osteoporosis Self-Assessment Tool (OST) and Fracture Risk Assessment Tool (FRAX) without BMD to discriminate between those with and without osteoporosis as defined by World Health Organization (WHO) diagnostic criteria, and between those recommended and not recommended for pharmacologic therapy based on the National Osteoporosis Foundation (NOF) guidelines. KEY RESULTS Among the cohort, 216 (5.3%) had a BMD T-score ≤ -2.5 at the femoral neck, total hip, or lumbar spine, and 1184 (29.2%) met criteria for consideration of pharmacologic therapy according to NOF guidelines. The OST had better discrimination (AUC 0.68) than the FRAX (AUC 0.62; p = 0.004) for identifying T-score-defined osteoporosis. Use of an OST threshold of <2 resulted in sensitivity of 0.83 and specificity of 0.36 for the identification of osteoporosis, compared to sensitivity of 0.59 and specificity of 0.59 for the use of FRAX with a cutoff of 9.3% 10-year risk of major osteoporotic fracture. CONCLUSIONS The OST performs modestly better than the more complex FRAX in selecting older men for BMD testing to screen for osteoporosis; the use of either tool substantially reduces the proportion of men referred for BMD testing compared to universal screening. Of 1000 men aged 70 and older in this community-based cohort, the use of an OST cutoff of <2 to select men for BMD testing would result in 654 men referred for BMD testing, of whom 44 would be identified as having osteoporosis, and nine with osteoporosis would be missed.
Collapse
Affiliation(s)
- Susan J Diem
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA.
| | - Katherine W Peters
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Margaret L Gourlay
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - John T Schousboe
- Park Nicollet Clinic & HealthPartners Institute, Minneapolis, MN, USA
- Division of Health Policy & Management, University of Minnesota, Minneapolis, MN, USA
| | - Brent C Taylor
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa Langsetmo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| |
Collapse
|
6
|
Boyanov MA, Czerwinski E, Shinkov A, Palička V, Lakatos P, Poiana C, Payer J, Killinger Z, Kocjan T, Lesnyak O, Holzer G, Resch H. Patterns in the Diagnosis and Treatment of Osteoporosis in Men: A Questionnaire-based Survey in Central and Eastern European Countries. ACTA MEDICA BULGARICA 2017. [DOI: 10.1515/amb-2017-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
SummaryTo assess the current practice patterns in the diagnosis and treatment of male osteoporosis based on questionnaires. Questionnaires were presented and filled out by osteoporosis experts from Austria, Bulgaria, the Czech Republic, Hungary, Poland, Romania, Slovakia, Slovenia and Russia. The questions included focused on the proportion of male referrals to DXA, the main reasons for referral, the preferred measurement sites and reference database, the definition of male osteoporosis, needed laboratory investigations, data on calcium and vitamin D supplementation as well as on treatment modalities and their reimbursement rate. Men comprised 5 to 10% of all DXA referrals. The main reasons for referral were low back pain and fractures. Most of the respondents used the International male reference database. The diagnosis of osteoporosis was based mainly on a T-score below −2.5 after the age of 50, but a few respondents added fractures as a necessary condition. Only 1/3 of men visiting DXA sites are expected to have normal BMD. A consensus for the use of laboratory investigations in male osteoporosis is practically lacking. Treatment modalities include alendronate, risedronate, zoledronate, denosumab, rhPTH and strontium (with some restrictions for the latter three). Data on treatment adherence and persistence are generally lacking except for Austria, Romania and Slovakia. The levels of reimbursement vary a lot across countries. Osteoporosis in men is an under-recognized problem in CEE countries, leading to a tremendous gap in the diagnosis and treatment.
Collapse
Affiliation(s)
- M. A. Boyanov
- Department of Internal Medicine, Clinic of Endocrinology and Metabolism , University Hospital “Alexandrovska”, Medical University – Sofia , Bulgaria
| | - E. Czerwinski
- Jagiellonian University Medical College , Faculty of Health Sciences, Department of Bone and Joint Diseases – Cracow , Poland
| | - A. Shinkov
- Clinic of Thyroid and Bone Metabolic Diseases , University Hospital of Endocrinology “Acad. Ivan Penchev”, Medical University – Sofia , Bulgaria
| | - V. Palička
- Osteocentra , University Hospital and Charles University , School of Medicine , Hradec Kralove , Czech Republic
| | - P. Lakatos
- 1st Department of Medicine , Semmelweis University – Budapеst , Hungary
| | - C. Poiana
- Department of Endocrinology, National Institute of Endocrinology , University of Medicine and Pharmacy – Bucharest , Romania
| | - J. Payer
- 5th Department of Internal Medicine , University Hospital, Medical Faculty of Comenius University , Bratislava , Slovakia
| | - Z. Killinger
- 5th Department of Internal Medicine , University Hospital, Medical Faculty of Comenius University , Bratislava , Slovakia
| | - T. Kocjan
- Department of Endocrinology, Diabetes and Metabolic Diseases , University Medical Centre Ljubljana – Ljubljana , Slovenia
| | - O. Lesnyak
- Urals State Medical University , Yekaterinburg – Russian Federation
- North-Western State Medical University , Saint Petersburg – Russian Federation
| | - G. Holzer
- Department of Orthopedic Surgery , Medical University of Vienna – Vienna , Austria
| | - H. Resch
- Metabolic Bone Diseases, Medical Faculty , “Sigmund Freud” University , Department of Internal Medicine II, St. Vincent Hospital Vienna , Academic Teaching Hospital of the Medical University – Vienna , Austria
| |
Collapse
|
7
|
Schousboe JT, Langsetmo L, Taylor BC, Ensrud KE. Fracture Risk Prediction Modeling and Statistics: What Should Clinical Researchers, Journal Reviewers, and Clinicians Know? J Clin Densitom 2017; 20:280-290. [PMID: 28712982 DOI: 10.1016/j.jocd.2017.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fractures are binary events (they either occur or they do not), and predicting whether fractures may occur involves assigning probabilities of one or more of those events occurring over time to populations and to individuals. Fracture risk prediction has become central to the management of osteoporosis and fracture prevention in clinical practice, and the ultimate clinical usefulness of the prediction tools used to estimate these risks depends, at a minimum, on the validity and accuracy of those tools. In this paper, we will describe how fracture prediction models are developed and validated, and how their performance characteristics are assessed. We will provide a checklist by which clinicians, clinical researchers, and reviewers of journal submissions can judge whether a fracture prediction tool meets basic requirements of good performance. We will further describe how the incremental predictive value of additional diagnostic tools, such as bone mass measurement technologies, is assessed.
Collapse
Affiliation(s)
- John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Minneapolis, MN, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Brent C Taylor
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Center for Chronic Diseases Outcomes Research, Minneapolis Veterans Administration Medical Center, Minneapolis, MN, USA
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Center for Chronic Diseases Outcomes Research, Minneapolis Veterans Administration Medical Center, Minneapolis, MN, USA
| |
Collapse
|
8
|
Mori T, Crandall CJ, Ganz DA. Cost-effectiveness of combined oral bisphosphonate therapy and falls prevention exercise for fracture prevention in the USA. Osteoporos Int 2017; 28:585-595. [PMID: 27726000 DOI: 10.1007/s00198-016-3772-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 09/11/2016] [Indexed: 12/24/2022]
Abstract
UNLABELLED We developed a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women without prior major osteoporotic fractures over a lifetime horizon. At ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a conventionally accepted threshold compared with bisphosphonates alone. INTRODUCTION The purpose of this study was to examine the cost-effectiveness of the combined strategy of oral bisphosphonate therapy for 5 years and falls prevention exercise for 1 year compared with either strategy in isolation. METHODS We calculated incremental cost-effectiveness ratios [ICERs] (2014 US dollars per quality-adjusted life year [QALY]), using a Markov microsimulation model among hypothetical cohorts of community-dwelling US white women with different starting ages (65, 70, 75, and 80) without prior history of hip, vertebral, or wrist fractures over a lifetime horizon from the societal perspective. RESULTS At ages 65, 70, 75, and 80, the combined strategy had ICERs of $202,020, $118,460, $46,870, and $17,640 per QALY, respectively, compared with oral bisphosphonate therapy alone. The combined strategy provided better health at lower cost than falls prevention exercise alone at ages 70, 75, and 80. In deterministic sensitivity analyses, results were particularly sensitive to the change in the opportunity cost of participants' time spent exercising. In probabilistic sensitivity analyses, the probabilities of the combined strategy being cost-effective compared with the next best alternative increased with age, ranging from 35 % at age 65 to 48 % at age 80 at a willingness-to-pay of $100,000 per QALY. CONCLUSIONS Among community-dwelling US white women ages 75 and 80, adding 1 year of exercise to 5 years of oral bisphosphonate therapy is cost-effective at a willingness-to-pay of $100,000 per QALY, compared with oral bisphosphonate therapy only. This analysis will help clinicians and policymakers make better decisions about treatment options to reduce fracture risk.
Collapse
Affiliation(s)
- T Mori
- Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan.
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - D A Ganz
- Geriatric Research, Education and Clinical Center and HSR&D Center for Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Health Unit, RAND Corporation, Santa Monica, CA, USA
| |
Collapse
|
9
|
Cawthon PM, Lui LY, McCulloch CE, Cauley JA, Paudel ML, Taylor B, Schousboe JT, Ensrud KE. Sarcopenia and Health Care Utilization in Older Women. J Gerontol A Biol Sci Med Sci 2016; 72:95-101. [PMID: 27402050 DOI: 10.1093/gerona/glw118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 06/05/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Although there are several consensus definitions of sarcopenia, their association with health care utilization has not been studied. METHODS We included women from the prospective Study of Osteoporotic Fractures with complete assessment of sarcopenia by several definitions at the Study of Osteoporotic Fractures Year 10 (Y10) exam (1997-1998) who also had available data from Medicare Fee- For-Service Claims (N = 566) or Kaiser Encounter data (N = 194). Sarcopenia definitions evaluated were: International Working Group, European Working Group for Sarcopenia in Older Persons, Foundation for the NIH Sarcopenia Project, Baumgartner, and Newman. Hurdle models and logistic regression were used to assess the relation between sarcopenia status (the summary definition and the components of slowness, weakness and/or lean mass) and outcomes that included hospitalizations, cumulative inpatient days/year, short-term (part A paid) skilled nursing facility stay in the 3 years following the Y10 visit. RESULTS None of the consensus definitions, nor the definition components of weakness or low lean mass, was associated with increased risk of hospitalization or greater likelihood of short-term skilled nursing facility stay. Women with slowness by any criterion definition were about 50% more likely to be hospitalized; had a greater rate of hospitalization days amongst those hospitalized; and had 1.8 to 2.1 times greater likelihood of a short-term skilled nursing facility stay than women without slowness. There was the suggestion of a protective association of low lean mass by the various criterion definitions on short-term skilled nursing facility stay. CONCLUSION Estimated effects of sarcopenia on health care utilization were negligible. However, slowness was associated with greater health care utilization.
Collapse
Affiliation(s)
- Peggy M Cawthon
- California Pacific Medical Center, Research Institute, San Francisco. .,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Li-Yung Lui
- California Pacific Medical Center, Research Institute, San Francisco
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Misti L Paudel
- Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, Minnesota
| | - Brent Taylor
- Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, Minnesota.,Department of Medicine.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - John T Schousboe
- Park Nicollet Clinic, St. Louis Park, Minnesota.,Division of Health Policy and Management, University of Minnesota, Minneapolis
| | - Kristine E Ensrud
- Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, Minnesota.,Department of Medicine.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| |
Collapse
|
10
|
Cauley JA, Lui LY, Paudel ML, Taylor BC, Cawthon PM, Hillier TA, Schousboe JT, McCulloch CE, Ensrud KE. Impact of radiographic vertebral fractures on inpatient healthcare utilization in older women. Bone 2016; 88:165-169. [PMID: 27131511 PMCID: PMC4899246 DOI: 10.1016/j.bone.2016.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Vertebral fractures (VFx) are the most common osteoporotic fracture and are associated with higher risk of impaired function, additional fractures and death. The purpose of this analysis was to test the hypotheses that VFx are also associated with greater inpatient healthcare utilization. METHODS We studied 4709 Caucasian women enrolled in the Study of Osteoporotic Fractures (SOF) and merged SOF cohort data with Medicare claims or Kaiser encounter data. To be included in this analysis, women had to be enrolled in Medicare Fee for Service or Kaiser as of 1/1/1991 and have radiographic information on VFx status at SOF Visit 3 (1991-92). VFx status was assessed using quantitative morphometry on lateral thoracic and lumbar spine radiographs. Prevalent VFx were defined as any height ratio>3 standard deviations below normal. Women were considered to have a clinical VFx if they reported a new diagnosis of VFx and a clinical radiographic report that confirmed that a VFx was present. Any hospitalization and the number of annualized days of hospitalization were identified through inpatient claims or encounter data. Specific hospitalizations for 5 major common reasons for hospitalizations were also examined. RESULTS Over 5-years, 2632 (55.9%) women were hospitalized. In multivariate adjusted models, women with a prevalent radiographic VFx were 21% (95% CI, 2-44%) more likely to be hospitalized for any reason. This association was independent of a number of risk factors including smoking. The annualized rate of inpatient day was, however, similar, 1.67 and 1.48 among women with and without a VFx, respectively, p=0.49. Women with an incident clinical VFx were more likely to be hospitalized including women without evidence of a prevalent radiographic VFx (odds ratio (OR)=5.33; 95% confidence interval (CI)=1.81-15.71) and women with a prevalent radiographic VFx (OR=2.13; 95% CI, 1.05-4.33). Women with a VFx were more likely to be hospitalized specifically for hip fracture or chronic obstructive pulmonary disease (COPD) but not stroke, myocardial infarction or congestive heart failure. The association with COPD was attenuated to non-significance after adjusting for smoking. CONCLUSION Our results extend the potential public health impact of radiographic and clinical VFx to include an increased risk of any hospitalization.
Collapse
Affiliation(s)
- Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Li-Yung Lui
- California Pacific Medical Center Research Institute, San Francisco, CA, United States.
| | - Misti L Paudel
- NORC at the University of Chicago, Health Care Department, Bethesda, MD, United States.
| | - Brent C Taylor
- NORC at the University of Chicago, Health Care Department, Bethesda, MD, United States; Department of Medicine, University of Minnesota, Minneapolis, MN, United States; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, United States.
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, United States.
| | - Teresa A Hillier
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States.
| | - John T Schousboe
- Park Nicollet Clinic, St. Louis Park, MN, United States; Division of Health Policy & Management, University of Minnesota, Minneapolis, MN, United States.
| | | | - Kristine E Ensrud
- NORC at the University of Chicago, Health Care Department, Bethesda, MD, United States; Department of Medicine, University of Minnesota, Minneapolis, MN, United States; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, United States.
| |
Collapse
|
11
|
Nayak S, Greenspan SL. Cost-Effectiveness of Osteoporosis Screening Strategies for Men. J Bone Miner Res 2016; 31:1189-99. [PMID: 26751984 PMCID: PMC4891297 DOI: 10.1002/jbmr.2784] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 02/06/2023]
Abstract
Osteoporosis affects many men, with significant morbidity and mortality. However, the best osteoporosis screening strategies for men are unknown. We developed an individual-level state-transition cost-effectiveness model with a lifetime time horizon to identify the cost-effectiveness of different osteoporosis screening strategies for US men involving various screening tests (dual-energy X-ray absorptiometry [DXA]; the Osteoporosis Self-Assessment Tool [OST]; or a fracture risk assessment strategy using age, femoral neck bone mineral density [BMD], and Vertebral Fracture Assessment [VFA]); screening initiation ages (50, 60, 70, or 80 years); and repeat screening intervals (5 years or 10 years). In base-case analysis, no screening was a less effective option than all other strategies evaluated; furthermore, no screening was more expensive than all strategies that involved screening with DXA or the OST risk assessment instrument, and thus no screening was "dominated" by screening with DXA or OST at all evaluated screening initiation ages and repeat screening intervals. Screening strategies that most frequently appeared as most cost-effective in base-case analyses and one-way sensitivity analyses when assuming willingness-to-pay of $50,000/quality-adjusted life-year (QALY) or $100,000/QALY included screening initiation at age 50 years with the fracture risk assessment strategy and repeat screening every 10 years; screening initiation at age 50 years with fracture risk assessment and repeat screening every 5 years; and screening initiation at age 50 years with DXA and repeat screening every 5 years. In conclusion, expansion of osteoporosis screening for US men to initiate routine screening at age 50 or 60 years would be expected to be effective and of good value for improving health outcomes. A fracture risk assessment strategy using variables of age, femoral neck BMD, and VFA is likely to be the most effective of the evaluated strategies within accepted cost-effectiveness parameters. DXA and OST are also reasonable screening options, albeit likely slightly less effective than the evaluated fracture risk assessment strategy. © 2016 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Smita Nayak
- Swedish Center for Research and Innovation, Swedish Health Services, Swedish Medical Center, Seattle, WA, USA
| | | |
Collapse
|
12
|
Cawthon PM, Shahnazari M, Orwoll ES, Lane NE. Osteoporosis in men: findings from the Osteoporotic Fractures in Men Study (MrOS). Ther Adv Musculoskelet Dis 2016; 8:15-27. [PMID: 26834847 DOI: 10.1177/1759720x15621227] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The lifespan of men is increasing and this is associated with an increased prevalence of osteoporosis in men. Osteoporosis increases the risk of bone fracture. Fractures are associated with increased disability and mortality, and public health problems. We review here the study of osteoporosis in men as obtained from a longitudinal cohort of community-based older men, the Osteoporotic Fractures in Men Study (MrOS).
Collapse
Affiliation(s)
| | - Mohammad Shahnazari
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, OR, USA
| | - Nancy E Lane
- UC Davis Health System, 4625 2nd Avenue, Suite 2006, Sacramento, CA 95817, USA
| |
Collapse
|
13
|
Lakatos P, Tóth E, Szekeres L, Poór G, Héjj G, Marton I, Takács I. Comparative statistical analysis of osteoporosis treatment based on Hungarian claims data and interpretation of the results in respect to cost-effectiveness. Osteoporos Int 2014; 25:2077-87. [PMID: 24819455 DOI: 10.1007/s00198-014-2733-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/22/2014] [Indexed: 01/30/2023]
Abstract
UNLABELLED The efficacy of interventions used in real life for the treatment of osteoporosis has not been evaluated on a national basis. We analysed the database of the single Hungarian health care provider between 2004 and 2010. A marked reduction in fracture incidence and hospitalization was seen, which also proved to be cost-effective. INTRODUCTION Osteoporosis and its consequences place a significant burden on the health care systems of developed countries. Present therapeutic modalities are effective in reducing the risk of fractures caused by osteoporosis. However, we do not know whether the interventions introduced in the past 15 years have significantly reduced the number of osteoporotic fractures in real life, and if yes, how cost-effectively. METHODS The database of the National Health Insurance Fund Administration in Hungary was analysed for the period between 2004 and 2010. Two specific patient groups were identified within the population. Patients, who were under osteoporosis treatment in more than 80% of the potential treatment days in three consecutive years (patients with high compliance), were compared with patients where this ratio was under 20% (patients with low compliance). Several statistical comparative models were implemented in order to capture a complete picture on the differences. Because of natural data heterogeneity of administration databases, propensity matching was applied as well. RESULTS Comparing treated vs. control subjects, patients with high compliance showed a significant decrease in fracture risk and hospitalization, which was more robust after propensity adjustment. On the basis of the observed statistically significant differences, cost-effectiveness analysis was implemented. Utility loss due the observed fractures was compared with the total cost differences of the two arms based on modelling. Our calculations proved the cost-effectiveness of the long-term high compliance in real world settings. CONCLUSION Our findings infer that the standardized and uniform health care of osteoporotic patients in a country may reduce general fracture incidence and hospitalization in a cost-effective way.
Collapse
Affiliation(s)
- P Lakatos
- 1st Department of Medicine, Semmelweis University, Korányi u. 2/A, Budapest, 1083, Hungary
| | | | | | | | | | | | | |
Collapse
|
14
|
Stevenson MD, Selby PL. Modelling the cost effectiveness of interventions for osteoporosis: issues to consider. PHARMACOECONOMICS 2014; 32:735-743. [PMID: 24715605 DOI: 10.1007/s40273-014-0156-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Expenditure on treating osteoporotic fractures and on preventative intervention is considerable and is likely to rise in forthcoming years due to the association between fracture risk and age. With funders such as the National Institute for Health and Care Excellence and the Pharmaceutical Benefits Advisory Committee explicitly considering cost-effectiveness analyses within the process of producing guidance, it is imperative that economic models are as robust as possible. This article details issues that need to be considered specifically related to health technology assessments of interventions for osteoporosis, and highlights limitations within the current evidence base. A likely direction of impact on cost effectiveness of addressing the key issues has been included alongside a tentative categorization of the level of these impacts. It is likely that cost-effectiveness ratios presented in previous models that did not address the identified issues were favourable to interventions.
Collapse
Affiliation(s)
- Matt D Stevenson
- University of Sheffield, School of Health and Related Research, 30 Regent Street, Sheffield, S1 4DA, UK,
| | | |
Collapse
|
15
|
Bleibler F, Rapp K, Jaensch A, Becker C, König HH. Expected lifetime numbers and costs of fractures in postmenopausal women with and without osteoporosis in Germany: a discrete event simulation model. BMC Health Serv Res 2014; 14:284. [PMID: 24981316 PMCID: PMC4118314 DOI: 10.1186/1472-6963-14-284] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 05/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoporotic fractures cause a large health burden and substantial costs. This study estimated the expected fracture numbers and costs for the remaining lifetime of postmenopausal women in Germany. METHODS A discrete event simulation (DES) model which tracks changes in fracture risk due to osteoporosis, a previous fracture or institutionalization in a nursing home was developed. Expected lifetime fracture numbers and costs per capita were estimated for postmenopausal women (aged 50 and older) at average osteoporosis risk (AOR) and for those never suffering from osteoporosis. Direct and indirect costs were modeled. Deterministic univariate and probabilistic sensitivity analyses were conducted. RESULTS The expected fracture numbers over the remaining lifetime of a 50 year old woman with AOR for each fracture type (% attributable to osteoporosis) were: hip 0.282 (57.9%), wrist 0.229 (18.2%), clinical vertebral 0.206 (39.2%), humerus 0.147 (43.5%), pelvis 0.105 (47.5%), and other femur 0.033 (52.1%). Expected discounted fracture lifetime costs (excess cost attributable to osteoporosis) per 50 year old woman with AOR amounted to € 4,479 (€ 1,995). Most costs were accrued in the hospital € 1,743 (€ 751) and long-term care sectors € 1,210 (€ 620). Univariate sensitivity analysis resulted in percentage changes between -48.4% (if fracture rates decreased by 2% per year) and +83.5% (if fracture rates increased by 2% per year) compared to base case excess costs. Costs for women with osteoporosis were about 3.3 times of those never getting osteoporosis (€ 7,463 vs. € 2,247), and were markedly increased for women with a previous fracture. CONCLUSION The results of this study indicate that osteoporosis causes a substantial share of fracture costs in postmenopausal women, which strongly increase with age and previous fractures.
Collapse
Affiliation(s)
- Florian Bleibler
- Department for Health Economics and Health Service Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr, 52, D-20246 Hamburg, Germany.
| | | | | | | | | |
Collapse
|
16
|
Abstract
Osteoporosis and related fractures disproportionately impact patients with advanced age, those with the frailty phenotype, and those with multiple comorbidities. Recent studies report a changing incidence in fracture type among the oldest old throughout the world, a finding not satisfactorily explained by advances in treatment of lifestyle factors. A growing recognition of the importance of muscle and bone interaction is leading to improved understanding of the underlying biochemical pathways linking them and new therapeutic targets. New models of care for frail older populations, particularly after hip fracture, are being developed but have been challenged to identify appropriate outcomes to target. An appreciation for the relationship between age-related comorbidities, fracture risk, and competing mortality risk is essential for practitioners caring for the oldest-old population.
Collapse
Affiliation(s)
- Cathleen S Colón-Emeric
- Duke University Medical Center and the Durham VA Geriatrics Research Education and Clinical Center, 508 Fulton St. GRECC 182, Durham, NC, 27705, USA,
| |
Collapse
|
17
|
Melton GB, Manaktala S, Sarkar IN, Chen ES. Social and behavioral history information in public health datasets. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2012; 2012:625-634. [PMID: 23304335 PMCID: PMC3540479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Social and behavioral history is increasingly recognized as integral for understanding important determinants of disease and critical for patient care, research, clinical guidelines, and public health policies. Social and behavioral history information in the public health domain, specifically large public health surveys, has not been well described. In this study, a content analysis was performed and information model constructed and contrasted with clinically-based models for each of three widely used public health surveys: BRFSS (Behavioral Risk Factor Surveillance System), NHANES (National Health and Nutrition Examination Survey), and NHIS (National Health Interview Survey). Survey items were predominantly related to alcohol use, drug use, occupation, and tobacco use. Although the clinical social history information model was similar, public health social history demonstrated additional complexity in coding temporality, degree of exposure, and certainty. Our results give insight into ongoing efforts to integrate clinical and public health information resources for improving and measuring health.
Collapse
Affiliation(s)
- Genevieve B Melton
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | | | | | | |
Collapse
|