Cost-Utility Analysis of Physicians' Guideline Adherence for Osteoporosis In Germany

Abstract

Osteoporosis is characterized by the occurrence of fractures due to reduced bone stability. Annual direct costs of osteoporosis are estimated at € 5.4 billion in Germany. Without changes in policy, fractures – the main cost driver – are expected to double by the year 2050. While a high-quality evidence-based guideline on screening and preventive treatments exist, only 52% of general practitioners stated to have knowledge of the guideline, which is expected to result in low levels of guideline adherence and implementation. Therefore, the objective of this study is to investigate the economic impact of a 20% increase (from currently assumed ≈50% to a target 70%) of guideline adoption rate by German primary care physicians. A health economic model was developed to investigate the cost impact and cost-utility of extended guideline implementation. Screening was modeled using a decision tree, subsequent treatment was modelled in a Markov approach, with one-year cycles simulated over lifetime. The modelled cohort comprised 381,583 women eligible for screening at age 70. The perspective of the statutory health insurance was applied; accordingly, prices from official formularies and fee schedules were used. Sensitivity analyses were performed to test the robustness of results. Increasing implementation of the guideline by 20% resulted in an additional screening of 76,317 women and treatment of 19,079 women at high fracture risk. 1,668 fractures were avoided, as were 588 subsequent deaths. Over lifetime, higher implementation led to 5,214 additional QALYs and additional costs of € 59 million, resulting in € 11,383 per QALY gained. A conservative 20% increase in implementation of the evidence-based guideline could substantially reduce fractures and increase quality of life, while showing a limited impact on the healthcare budget. From a health economic point of view, a comprehensive implementation of the guideline, by increasing physicians’ guideline adherence, appears recommendable.