Analytical approach:
The authors used a decision analytical model to synthesise data from a range of sources in assessing the cost-effectiveness of treatment for osteoporosis across age ranges. The time horizon of the analysis was lifetime. The authors stated that the study perspective was societal.
Effectiveness data:
The main clinical effectiveness estimates were: population risk of fracture based on results from a cohort study and a published background risk estimate; mortality after fracture; efficacy of oral bisphosphonates from published meta-analyses; and alternative scenarios of treatment adherence.
Monetary benefit and utility valuations:
Utility estimates were obtained for acute and post-fracture health states for hip, vertebral and other sites. The sources of utility data were a systematic review of utilities associated with osteoporosis and age-specific utility estimates from the published literature. Healthcare benefits were discounted at a rate of 3% per year.
Measure of benefit:
The measure of benefit was the number of quality-adjusted life years (QALYs) gained.
Cost data:
The cost categories included direct costs associated with administration of bisphosphonates (drugs, physician time and x-ray absorptiometry scans) and treatment of hip fractures and indirect costs of long-term care associated with hip fracture. Drug costs were taken from the Drug Topics Red Book. Physician time and scans were taken from the Physician Fee Schedule 2009. Costs of treatment and long-term care associated with hip fractures were based on estimates from the published literature. Costs were provided in 2008 US Dollars ($) and were discounted at a rate of 3% per year.
Analysis of uncertainty:
The authors conducted one-way sensitivity analysis to assess the impact on results of uncertainty in the key parameters and presented the result using cost-effectiveness acceptability curves.