Table 1.
Summary of key parameters in the health economics model
| Parameter | Model input | Distribution in PSA |
|---|---|---|
| Prevalence of osteoporosis (%)2 | 14.2 (60–69 years), 26.8 (70–79 years), 39.2 (80+ years) | – |
| Fracture incidence (annual rate per 1,000 person-years) | ||
| Hip15 | 0.96 (65–69 years), 2.33 (70–74 years), 4.08 (75–79 years), 6.44 (80–84 years), 6.59 (85–89 years), 8.67 (90+ years) | – |
| Clinical vertebral16 | 5.64 (65–69 years), 8.74 (70–74 years), 12.05 (75–79 years), 21.19 (80–84 years), 26.89 (85–89 years), 27.10 (90+ years) | – |
| Wrist17 | 12.95 (65–69 years), 13.17 (70–74 years), 13.87 (75–79 years), 15.01 (80–84 years), 15.10 (85–89 years), 13.97 (90+ years) | – |
| Mortality rate (per 1,000) for general population19 | 10.31 (65–69 years), 20.36 (70–74 years), 37.84 (75–79 years), 69.98 (80–84 years), 136.03 (85+ years) | – |
| SMR after a hip fracture3 | 2.43 (95% CI =2.02–2.93) | Lognormal |
| SMR after a clinical vertebral fracture3 | 1.82 (95% CI =1.52–2.17) | Lognormal |
| SMR after a wrist fracture3 | 1.42 (95% CI =1.19–1.70) | Lognormal |
| Relative risk for fracture with alendronate treatment23 | ||
| Primary prevention, nonvertebral | 0.89 (95% CI =0.76–1.04) | Lognormal |
| Secondary prevention, nonvertebral | 0.77 (95% CI =0.64–0.92) | Lognormal |
| Primary prevention, vertebral | 0.55 (95% CI =0.38–0.80) | Lognormal |
| Secondary prevention, vertebral | 0.55 (95% CI =0.43–0.69) | Lognormal |
| Relative risk for fracture with calcium combined with vitamin D treatment21 | 0.88 (95% CI =0.78–0.99) | Lognormal |
| Relative risk for fracture with calcitonin treatment22 | ||
| Nonvertebral | 0.80 (95% CI =0.59–1.09) | Lognormal |
| Vertebral | 0.79 (95% CI =0.62–1.00) | Lognormal |
| Relative risk for fracture with raloxifene treatment8 | ||
| Non-vertebral | 0.92 (95% CI =0.79–1.07) | Lognormal |
| Vertebral | 0.60 (95% CI =0.50–0.70) | Lognormal |
| Medication persistence29 | ||
| Raloxifene | 0.502 (year 1), 0.401 (year 2) | – |
| Alendronate | 0.571 (year 1), 0.418 (year 2) | – |
| Calcitonin | 0.329 (year 1), 0.235 (year 2) | – |
| Medication adherence29,a | ||
| Raloxifene | 0.546 (year 1), 0.437 (year 3) | – |
| Alendronate | 0.619 (year 1), 0.479 (year 3) | – |
| Calcitonin | 0.364 (year 1), 0.364 (year 3) | – |
| Costs (2015 USD) | ||
| Annual nursing home25 | 4,570 | – |
| Hip fracture, inpatient5 | 6,720 | – |
| Vertebral fracture, inpatient5 | 5,079 | – |
| Wrist fracture, inpatient5 | 2,059 | – |
| Alendronate, annual cost25 | 1,144 | – |
| Calcitonin, annual cost25 | 745 | – |
| Raloxifene, annual cost25 | 1,056 | – |
| Calcium combined with vitamin D, annual cost25 | 93 | – |
| HSUVs for osteoporotic patients without fractures28 | 0.806 (65–69 years), 0.747 (70–74 years), 0.731 (75–79 years), 0.699 (80–84 years), 0.676 (85+ years) | – |
| HSUV multipliers4,b | ||
| Hip fracture, first year | 0.776 (95% CI =0.720–0.844) | Beta |
| Hip fracture, subsequent years | 0.855 (95% CI =0.800–0.909) | Beta |
| Vertebral fracture, first year | 0.724 (95% CI =0.667–0.779) | Beta |
| Vertebral fracture, subsequent years | 0.868 (95% CI =0.827–0.922) | Beta |
| Wrist fracture, first year | 1.000 (95% CI =0.960–1.000) | Triangular |
| Wrist fracture, subsequent years | 1.000 (95% CI =0.930–1.000) | Triangular |
| Annual discount rates20 | ||
| Costs | 0.03 | – |
| Effectiveness | 0.03 | – |
Notes:
a
Medication adherence is measured by MPR; MPR ≥0.8 was defined as high adherent.
b
Multipliers for the proportionate effects of fractures on HSUVs, calculated using data taken from Osteoporos Int. 2014;25(8):1–11. A systematic review and meta-analysis of utility-based quality of life for osteoporosis-related conditions. Si L, Winzenberg TM, de Graaff B, Palmer AJ, © International Osteoporosis Foundation and National Osteoporosis Foundation 2014. With permission of Springer.4
Abbreviations: HSUV, health-state utility value; MPR, medication possession rate; PSA, probabilistic sensitivity analysis; SMR, standardized mortality ratio; USD, United States Dollars.