A health economic simulation model for the clinical management of osteoporosis

• Published in: Osteoporosis international 2018-03, Vol.29 (3), p.545-555
• Main Authors: Jonsson, E., Hansson-Hedblom, A., Ljunggren, Ö., Åkesson, K., Spångeus, A., Kanis, J. A., Borgström, F.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Bone Density; Bone Density Conservation Agents - economics; Bone Density Conservation Agents - therapeutic use; Clinical Medicine; Cost; Cost analysis; Cost control; Cost-Benefit Analysis; Disease management; Drug Substitution - economics; Drug therapy; Economics; Endocrinology; Female; Fracture; Health Care Costs - statistics & numerical data; Health Care Service and Management, Health Policy and Services and Health Economy; Health Sciences; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Hälsovetenskap; Klinisk medicin; Male; Medical and Health Sciences; Medication Adherence - statistics & numerical data; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Models, Econometric; Original Article; Orthopedics; Ortopedi; Osteoporosis; Osteoporosis - diagnosis; Osteoporosis - drug therapy; Osteoporosis - economics; Osteoporosis - epidemiology; Osteoporotic Fractures - economics; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - prevention & control; Quality of Life; Quality-Adjusted Life Years; Register; Registries; Rheumatology; Sweden; Sweden - epidemiology
• ISSN: 0937-941X; 1433-2965; 1433-2965
• DOI: 10.1007/s00198-017-4325-4

Summary The objective was to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice. Results showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings. Introduction The purpose of this study is to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice. Methods The analysis was carried out using a model that simulates the individual patients considered for pharmacological treatment during 1 year and their projected osteoporosis treatment pathway, quality-adjusted life years (QALYs) and costs over their remaining lifetime. All patients regardless of treatment or no treatment were simulated. Information on current management of osteoporosis in terms of patient characteristics and treatment patterns were derived from a Swedish osteoporosis research database based on national registers and patient records. Current (standard) clinical management was compared with alternative scenarios mirroring Swedish treatment guidelines. Results The national burden in terms of lost QALYs was estimated at 14,993 QALYs and the total economic cost at €776M. Scenario analyses showed that 382–3864 QALYs could be gained at a cost/QALY ranging from cost-saving to €31368, depending on the scenario. The margin of investment, i.e. the maximum amount that could be invested in the healthcare system to achieve these improvements up to the limit of the willingness to pay/QALY, was estimated at €199M on a population level (€3,634/patient). Conclusions The analysis showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings. From a cost-effectiveness perspective, there is also considerable room for investment to achieve these improvements in the management of osteoporosis.