| Cost-effectiveness of osteoporosis interventions for 'incidental' vertebral fractures. | |
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MedLine Citation:
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PMID: 23331449 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Vertebral fractures detected "incidentally" by chest radiograph usually do not trigger osteoporosis treatment in older patients. In a 3-arm controlled trial we reported that both physician-directed and enhanced (physician plus patient activation) interventions increased treatment rates more than 10-fold (15%-20% absolute increases) compared with usual care; the cost-effectiveness of these interventions is unknown. METHODS: Incremental cost-effectiveness of these 2 interventions compared with usual care was assessed using a Markov decision-analytic model, populated with 1-year outcomes data and direct intervention costs from the trial. Costs were expressed in 2009 Canadian dollars and effectiveness based on quality-adjusted life years (QALYs) gained. The perspective was health care payer; horizon was projected lifetime; costs and benefits were discounted at 3%; and deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Per patient, the physician and enhanced interventions cost $34 and $42, respectively. Compared with usual care, for every 1000 patients exposed to the physican intervention there were 4 fewer fractures, 8 more QALYs gained, and $282,000 saved. Compared with physician interventions, for every 1000 patients exposed to enhanced interventions there were 6 fewer fractures, 6 more QALYs gained, and $339,000 saved. Both interventions dominated usual care and were cost-effective in ∼80% of 10,000 probabilistic simulations. Although the enhanced intervention cost $8 more per patient, it still dominated the physician intervention and usual care, and was the most economically attractive option. CONCLUSIONS: Pragmatic and inexpensive interventions directed at patients with incidentally detected vertebral fractures and their physicians are highly cost-effective at improving osteoporosis treatment, and in most circumstances also are cost-saving. |
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Authors:
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Sumit R Majumdar; Douglas A Lier; Finlay A McAlister; Brian H Rowe; Kerry Siminoski; David A Hanley; Anthony S Russell; Jeffrey A Johnson |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The American journal of medicine Volume: 126 ISSN: 1555-7162 ISO Abbreviation: Am. J. Med. Publication Date: 2013 Feb |
Date Detail:
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Created Date: 2013-01-21 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0267200 Medline TA: Am J Med Country: United States |
Other Details:
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Languages: eng Pagination: 169.e9-169.e17 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2013 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada. Electronic address: me2.majumdar@ualberta.ca. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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