Economic evaluations of interventions for the prevention and treatment of osteoporosis: a structured review of the literature

TY - JOUR

T1 - Economic evaluations of interventions for the prevention and treatment of osteoporosis

T2 - a structured review of the literature

AU - Fleurence, R L

AU - Iglesias, C P

AU - Torgerson, D J

PY - 2006/1

Y1 - 2006/1

N2 - Economic evaluations are increasingly being used by decision-makers to estimate the cost-effectiveness of interventions. The objective of this study was to conduct a structured review of economic evaluations of interventions to prevent and treat osteoporosis. Articles were identified independently by two reviewers through searches on MEDLINE, the bibliographies of reviews and identified economic models, and expert opinion, using predefined inclusion and exclusion criteria. Data on country, type and level of interventions, type of fractures, interventions, study population and the authors' stated conclusions were extracted. Forty-two relevant studies were identified. The majority of studies (71%) were conducted in Sweden, the UK and the US. The main interventions investigated were hormone replacement therapy (27%), bisphosphonates (17%) and combinations of vitamin D and calcium (16%). In 38% of studies, hip fracture was the sole fracture outcome. Eighty-eight percent (88%) of studies investigated female populations only. A relatively large number of economic evaluations were identified in the field of osteoporosis. Major changes have recently occurred in the treatment of this disease, following the publication of the results of the Women's Health Initiative trial. Methodological developments in economic evaluations, such as the use of probabilistic sensitivity analysis and cost-effectiveness acceptability curves, have also taken place. Such changes are reflected in the studies that were reviewed. The development of economic models should be an iterative process that incorporates new information, whether clinical or methodological, as it becomes available.

AB - Economic evaluations are increasingly being used by decision-makers to estimate the cost-effectiveness of interventions. The objective of this study was to conduct a structured review of economic evaluations of interventions to prevent and treat osteoporosis. Articles were identified independently by two reviewers through searches on MEDLINE, the bibliographies of reviews and identified economic models, and expert opinion, using predefined inclusion and exclusion criteria. Data on country, type and level of interventions, type of fractures, interventions, study population and the authors' stated conclusions were extracted. Forty-two relevant studies were identified. The majority of studies (71%) were conducted in Sweden, the UK and the US. The main interventions investigated were hormone replacement therapy (27%), bisphosphonates (17%) and combinations of vitamin D and calcium (16%). In 38% of studies, hip fracture was the sole fracture outcome. Eighty-eight percent (88%) of studies investigated female populations only. A relatively large number of economic evaluations were identified in the field of osteoporosis. Major changes have recently occurred in the treatment of this disease, following the publication of the results of the Women's Health Initiative trial. Methodological developments in economic evaluations, such as the use of probabilistic sensitivity analysis and cost-effectiveness acceptability curves, have also taken place. Such changes are reflected in the studies that were reviewed. The development of economic models should be an iterative process that incorporates new information, whether clinical or methodological, as it becomes available.

KW - cost-effectiveness

KW - economics

KW - fractures

KW - model

KW - osteoporosis

KW - review

KW - HORMONE REPLACEMENT THERAPY

KW - RANDOMIZED CONTROLLED-TRIAL

KW - COST-EFFECTIVENESS ANALYSIS

KW - ESTROGEN PLUS PROGESTIN

KW - POSTMENOPAUSAL WOMEN

KW - VERTEBRAL FRACTURES

KW - HIP PROTECTORS

KW - ESTABLISHED OSTEOPOROSIS

KW - BREAST-CANCER

KW - HEART-DISEASE

U2 - 10.1007/s00198-005-1943-z

DO - 10.1007/s00198-005-1943-z

M3 - Article

VL - 17

SP - 29

EP - 40

JO - Osteoporosis International

JF - Osteoporosis International

SN - 0937-941X

IS - 1

ER -