Cost-effective osteoporosis treatment thresholds in Greece.

Abstract

A Greek-specific cost-effectiveness analysis determined the FRAX-based intervention thresholds. Assuming a willingness to pay of 30,000 <euro>, osteoporosis treatment is cost-effective in subjects under the age of 75 with 10-year probabilities for hip and major osteoporotic fractures of 2.5 and 10%, respectively, while for older patients, the same thresholds are raised to 5 and 15%. The purpose of this study was to determine the FRAX calculated fracture probabilities at which therapeutic intervention can be considered as cost-effective in the Greek setting. A Markov cohort model was populated with Greek data, and quality-adjusted life years (QALYs) were used to calculate the cost-effective thresholds for an annual medication cost of 733.7 <euro> by gender and age. Average FRAX-based 10-year probabilities for both major osteoporotic and hip fractures were multiplied by the model-derived relative risk at which a cost of 30,000 <euro> for each QALY gained was observed for treatment versus to no intervention. A biphasic intervention threshold model is supported by our findings. Osteoporosis treatment becomes cost-effective when absolute 10-year probabilities for hip and major osteoporotic fractures reach 2.5 and 10%, respectively, among both men and women under the age of 75. For older subjects, the proposed intervention thresholds are raised to 5 and 15% 10-year probability for hip and major osteoporotic fractures, respectively. Cost-effective osteoporosis treatment may be facilitated in Greece if FRAX algorithm is used to identify subjects with 10-year probabilities for hip and major osteoporotic fractures of 2.5 and 10%, under the age of 75, while for older patients, the relevant thresholds are 5 and 15%, respectively.