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Volumn 8, Issue 1, 2010, Pages 49-55

Is osteoporosis disease management cost effective?

Author keywords

Bisphosphonate; Fracture; FRAX; Hip; Osteoporosis; PTH

Indexed keywords

ALENDRONIC ACID; BISPHOSPHONIC ACID DERIVATIVE;

EID: 77953613882     PISSN: 15441873     EISSN: 15442241     Source Type: Journal    
DOI: 10.1007/s11914-010-0009-0     Document Type: Review
Times cited : (45)

References (39)
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    • Curtis JR, Adachi JD, Saag KG: Bridging the osteoporosis quality chasm. J Bone Miner Res 2009, 24:3-7. There are a growing number of well-studied therapeutic options and emerging international consensus on what constitutes quality in osteoporosis and who needs to be treated. As a stark distinction from this evidence base, the care gap between adults at high osteoporosis risk and the delivery of optimal osteoporosis management is large. The osteoporosis care gap needs to be narrowed to reduce health care disparities and the burden of fractures. Evidence of implementation strategies that directly target providers, patients, and health care systems offer partial solutions.
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    • Vondracek SF, Linnebur SA: Diagnosis and management of osteoporosis in the older senior. Clin Interv Aging 2009, 4:121-136. It is important for health care providers to be fully aware of the potential risks and benefits of diagnosing and treating osteoporosis in the older senior population. Data indicate that bone mineral density (BMD) testing is underutilized and drug therapy is often not initiated when indicated in this population. BMD testing with central DXA is essential and cost effective in this population.
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    • By using the Osteoporosis Self- Assessment Index, based only on age and weight and fracture history, a case-finding strategy was developed for patients who needed DXA screening. This strategy nearly tripled referrals for DXA, and 96% of patients found to have osteoporosis had treatment. This indicates the need for better case-finding strategies with fewer barriers for referral for DXA and with higher accuracy for predicting osteoporosis
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    • The redesigned process was highly effective in improving BMD testing for women 65 years of age. The shared medical appointment was shown to be a more effective method to make calcium and vitamin D recommendations, to evaluate secondary causes of low bone density, and to prescribe prescription medications, compared with the usual care with the primary care physician
    • Ayoub WT, Newman ED, Blosky MA, et al.: Improving detection and treatment of osteoporosis: redesigning care using the electronic medical record and shared medical appointments. Osteoporos Int 2009, 20:37-42. The redesigned process was highly effective in improving BMD testing for women 65 years of age. The shared medical appointment was shown to be a more effective method to make calcium and vitamin D recommendations, to evaluate secondary causes of low bone density, and to prescribe prescription medications, compared with the usual care with the primary care physician.
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    • The new WHO fracture prediction algorithm was combined with an updated economic analysis to evaluate existing NOF guidance for osteoporosis prevention and treatment. It is cost effective to treat patients with a fragility fracture and those with osteoporosis by WHO criteria, as well as older individuals at average risk and osteopenic patients with additional risk factors. However, the estimated 10-year fracture probability was lower in men and nonwhite women compared with postmenopausal white women
    • Dawson-Hughes B, Tosteson AN, Melton LJ 3rd, et al.: Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. National Osteoporosis Foundation Guide Committee. Osteoporos Int 2008, 19:449-458. The new WHO fracture prediction algorithm was combined with an updated economic analysis to evaluate existing NOF guidance for osteoporosis prevention and treatment. It is cost effective to treat patients with a fragility fracture and those with osteoporosis by WHO criteria, as well as older individuals at average risk and osteopenic patients with additional risk factors. However, the estimated 10-year fracture probability was lower in men and nonwhite women compared with postmenopausal white women.
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    • Ettinger B, Black DM, Dawson-Hughes B, et al.: Updated fracture incidence rates for the US version of FRAX. Osteoporos Int 2010, 21:25-33. Compared with rates used in the current FRAX tool, 2006 hip fracture rates are about 16% lower, with the greatest reductions observed among those below 65 years of age; major osteoporotic fracture rates are about one quarter lower, with similar reductions across all ages.
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    • The article uses FRAX in a case-finding strategy, based on the assessment of fracture probability using CRFs and, where appropriate, additional testing such as BMD, is recommended. These case-finding strategies have been validated from a health-economic perspective
    • Kanis JA, McCloskey EV, Johansson H, Oden A: Approaches to the targeting of treatment for osteoporosis. Nat Rev Rheumatol 2009, 5:425-431. The article uses FRAX in a case-finding strategy, based on the assessment of fracture probability using CRFs and, where appropriate, additional testing such as BMD, is recommended. These case-finding strategies have been validated from a health-economic perspective.
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    • The osteoporosis guidelines from NICE and others mentioned earlier has raised some controversy. A major concern has been that despite a sixfold reduction in the price of alendronate, the estimates of cost effectiveness have barely changed. This has been achieved by alteration of some of the model assumptions, in the absence of new evidence, so that the cost effectiveness of alendronate has remained unchanged despite its fall in price. Furthermore, these changes to the model have had a negative impact on the cost effectiveness of the other treatments under consideration
    • Kanis JA, Compston JE.: NICE continues to muddy the waters of osteoporosis. National Osteoporosis Guideline Group of the UK. Osteoporos Int 2008, 19:1105-1107. The osteoporosis guidelines from NICE and others mentioned earlier has raised some controversy. A major concern has been that despite a sixfold reduction in the price of alendronate, the estimates of cost effectiveness have barely changed. This has been achieved by alteration of some of the model assumptions, in the absence of new evidence, so that the cost effectiveness of alendronate has remained unchanged despite its fall in price. Furthermore, these changes to the model have had a negative impact on the cost effectiveness of the other treatments under consideration.
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    • · Compston J, Cooper A, Cooper C, et al.: Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. National Osteoporosis Guideline Group (NOGG). Maturitas 2009, 62:105-108. Patients are identified opportunistically using a case-finding strategy on the finding of a previous fragility fracture or the presence of significant CRFs. Some of these risk factors act independently of BMD to increase fracture risk, whereas others increase fracture risk through their association with low BMD (eg, some of the secondary causes of osteoporosis).
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