Challenges for Model-Based Economic Evaluations of Postmenopausal Osteoporosis Interventions

Abstract

Assessing the cost-effectiveness of long-term treatment for osteoporosis requires use of mathematical models to estimate health effects and costs for competing interventions. The primary motivations for model-based analyses include the lack of long-term clinical trial outcome data and the lack of data comparing all relevant treatments within randomized clinical trials. We report on specific modeling challenges that arose in the development of a model of the natural history of postmenopausal osteoporosis that is suitable for assessing the cost-effectiveness of osteoporosis interventions among various population subgroups in diverse countries. These include choice of modeling changes in bone mineral density (BMD) or in fracture rate, definition of health states, modeling mortality and costs of long-term care following fracture, incorporation of health utility, and model validation. This report should facilitate future postmenopausal osteoporosis model development and provide insight for decision-makers who must evaluate model-based economic analyses of postmenopausal osteoporosis interventions.

Cost-effectiveness of alendronate for the treatment of osteopenic postmenopausal women in Japan

“…(8) We modeled residual effects of alendronate, assuming a linear decline in efficacy over 5 years, after 5 years of treatment. (13,29) In this model, full compliance with alendronate treatment was assumed, and loss of efficacy due to partial adherence was considered in a sensitivity analysis using the following formula: efficacy in subjects with partial adherence…”

Excess mortality following hip fracture: the role of underlying health status

“…costs of interventions relative to their effectiveness, as measured by impact on mortality and morbidity in formal cost-effectiveness analyses (4)(5)(6)). …”

Treating osteoporosis in Canada: what clinical efficacy data should be considered by policy decision makers?

“…All patients start off in the healthy state, which represents the cohort of women who enter the model. Details of the model design, structure, assumptions, and validation have been previously described [18,19]. Fractures averted was chosen as the primary outcome of interest in our hypothetical cohort, due to the substantial disability [20] and costs associated with fracture [5].…”