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Costo-efficacia della prevenzione delle fratture di femore [Cost-effectiveness of hip fracture prevention] |
Visentin P, Ciravegna R, Corcelli F, Fabris F |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of vitamin D3 and alendronate for prevention of hip fractures in elderly women.
Economic study type Cost-effectiveness analysis.
Study population Institutionalised elderly women and non-institutionalised women screened for bone mineral density.
Setting Hospital. The economic study was conducted in Turin, Italy.
Dates to which data relate The main effectiveness data were taken from previously published studies conducted between 1992 and 1996. Resource and cost data were mainly derived from 1992-1996 sources. The price year was not stated.
Source of effectiveness data The estimate of effectiveness was based on a review of previously completed studies.
Outcomes assessed in the review The outcome assessed was the number of necessary treatments to avoid one hip fracture and efficacy of treatment.
Study designs and other criteria for inclusion in the review The inclusion design was randomized controlled trials, multi-centred and double-blinded. No other inclusion/exclusion criteria were stated.
Sources searched to identify primary studies Criteria used to ensure the validity of primary studies Methods used to judge relevance and validity, and for extracting data Number of primary studies included 2 studies were included in the review.
Methods of combining primary studies Investigation of differences between primary studies The study populations considered in the two primary studies, respectively were, institutionalised elderly women and non-institutionalised women with a reduced bone mineral density.
Results of the review The number of necessary treatments to avoid one hip fracture was 58 with vitamin D3 and 261 with alendronate, (CI 95%). The efficacy of vitamin D3 was 0.70 (CI 95%) and the efficacy of alendronate was 0.49 (CI 95%).
Measure of benefits used in the economic analysis The benefit measure was hip fractures avoided.
Direct costs The cost of treatment and the cost of medical staff were included in the analysis. The quantities were reported separately from the costs. A discounting rate of 6.75% was applied. The quantity/cost boundary adopted was the hospital. The price year was not stated.
Statistical analysis of costs 95% confidence intervals were reported.
Sensitivity analysis No sensitivity analysis was performed.
Estimated benefits used in the economic analysis The benefits were not explicitly reported but were given within the synthesis of costs and benefits (i.e.the cost to avoid one hip fracture).
Cost results The total cost was L427,000 for the vitamin D3 and L1,415,000 for alendronate. The total saving of resources was L107,313,000.
Synthesis of costs and benefits The cost per hip fracture prevented was -L4,000,000 and L275,000 for vitamin D3 and for alendronate, respectively.
Authors' conclusions The cost-effectiveness analysis strengthens the conclusions of the clinical trials in that the prevention of hip fractures with vitamin D3 can be obtained at zero cost. However, the cost-effectiveness analysis weakens the conclusions of the clinical trials in that the prevention of the hip fracture with alendronate has unsustainable costs for the community.
CRD COMMENTARY - Selection of comparators The reason for the choice of the comparator is clear. Hip fractures are the most indicative end-point for the analysis of the prevention of complications associated with osteoporosis. As stated by the authors, the analysis is limited to vitamin D3 and alendronate preventive treatments due to their high comparability. Difficulties in comparability prevented the inclusion of alternative preventive strategies such as hormonal therapy or external hip protectors on hip fractures. You, as a user of this database, should consider whether these are widely used health technology in your own setting. Validity of estimate of measure of benefit The estimate of benefit, namely hip fractures avoided, would appear to be valid and was based on a systematic review, although this review only identified two trials. Validity of estimate of costs Resource quantities were reported separately from the prices. Adequate details of methods of quantity/ cost estimation were given. However, the costing methodology lacked some details; in particular the price year was not stated. No important cost items appear to have been omitted. Other issues The authors' conclusions are likely to be justified given the uncertainties in the data and the limited sources of data used. The issue of generalisability to other settings/countries was not addressed. However, appropriate comparisons were made with other studies supporting the clinical results from the present investigation, and in relation to cost-effectiveness results of alternative preventive strategies. The robustness of the results was not examined using, for example, decision tree analysis or sensitivity analysis. Bibliographic details Visentin P, Ciravegna R, Corcelli F, Fabris F. Costo-efficacia della prevenzione delle fratture di femore. [Cost-effectiveness of hip fracture prevention] Epidemiologia e Prevenzione 1998; 22(1): 44-48 Other publications of related interest 1. Chapuy M C, Arlot M E, Du Boeuf F et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. New England Journal of Medicine 1992;327:1637-1642.
2. Black D M, Cummings S R, Karpf D B et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996;348:1535-1541.
Indexing Status Subject indexing assigned by NLM MeSH Aged; Aged, 80 and over; Cost-Benefit Analysis; Costs and Cost Analysis; Female; Hip Fractures /economics /etiology /prevention & Humans; Italy; Osteoporosis /complications /therapy; control AccessionNumber 21998006844 Date bibliographic record published 31/07/1999 Date abstract record published 31/07/1999 |
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