Article type
Year
Abstract
Introduction:
Objectives: To assess the potential for incorporating the strict methodological guidelines of the Cochrane Collaboration into economic evaluation through the examination of the cost-effectiveness of nasal calcitonin (miacalcin) in postmenopausal women in comparison with no therapy.
Methods: First, an extensive literature search of the evidence of the efficacy of miacalcin was conducted based on the methods of the Cochrane Collaboration. The review provided estimates of the relative risk reduction in fractures associated with therapy, which will be used to model the annual reduction in fractures due to treatment. Secondly, an exercise was conducted to generate utility values associated with health states relevant to the treatment and management ofosteoporosis. Thirdly, estimates of the costs associated with fractures and the baseline probabilities of clinical events were estimated from a detailed literature review. Finally, an economic model was created incorporating clinical probabilities, cost and utility. Base case analysis was conducted for a 60-year-old woman on therapy for 10 years with a linear reduction in benefit for 10 years post treatment curtailment. Costs and benefits were discounted at 5% per annum.
Results: Interim results of the Cochrane meta-analysis estimate a pooled relative risk of vertebral fracture with treatment by calcitonin 200 IU of 0.66 (95% CI: 0.49 to 0.90). Similar relative risk reductions were found for hip and wrist fractures. Analysis based on assumptions relating to these results estimate that treatment will lead to a reduction in lifetime risk of fracture of 8% and an increase in both life years and QALYS of around 0.1. With an incremental discounted cost of treatment of $l 480, the incremental cost per life years and QALYs gained was less than $50 000. Results were robust to most sensitivity analyses except for assumptions relating-to the side effects of therapy.
Discussion: The results demonstrate the potential for incorporating the strict methodological guidelines of the Cochrane Collaboration into economic evaluations. Further analysis will involve replication of the Cochrane meta analysis methods for both alendronate and etidronate to allow estimation of the incremental cost-effectiveness of miacalcin in comparison to other alternate therapies for osteoporosis.
Objectives: To assess the potential for incorporating the strict methodological guidelines of the Cochrane Collaboration into economic evaluation through the examination of the cost-effectiveness of nasal calcitonin (miacalcin) in postmenopausal women in comparison with no therapy.
Methods: First, an extensive literature search of the evidence of the efficacy of miacalcin was conducted based on the methods of the Cochrane Collaboration. The review provided estimates of the relative risk reduction in fractures associated with therapy, which will be used to model the annual reduction in fractures due to treatment. Secondly, an exercise was conducted to generate utility values associated with health states relevant to the treatment and management ofosteoporosis. Thirdly, estimates of the costs associated with fractures and the baseline probabilities of clinical events were estimated from a detailed literature review. Finally, an economic model was created incorporating clinical probabilities, cost and utility. Base case analysis was conducted for a 60-year-old woman on therapy for 10 years with a linear reduction in benefit for 10 years post treatment curtailment. Costs and benefits were discounted at 5% per annum.
Results: Interim results of the Cochrane meta-analysis estimate a pooled relative risk of vertebral fracture with treatment by calcitonin 200 IU of 0.66 (95% CI: 0.49 to 0.90). Similar relative risk reductions were found for hip and wrist fractures. Analysis based on assumptions relating to these results estimate that treatment will lead to a reduction in lifetime risk of fracture of 8% and an increase in both life years and QALYS of around 0.1. With an incremental discounted cost of treatment of $l 480, the incremental cost per life years and QALYs gained was less than $50 000. Results were robust to most sensitivity analyses except for assumptions relating-to the side effects of therapy.
Discussion: The results demonstrate the potential for incorporating the strict methodological guidelines of the Cochrane Collaboration into economic evaluations. Further analysis will involve replication of the Cochrane meta analysis methods for both alendronate and etidronate to allow estimation of the incremental cost-effectiveness of miacalcin in comparison to other alternate therapies for osteoporosis.