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Cost-effectiveness of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA

OBJECTIVE: To evaluate the cost-effectiveness of routine administration of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA. DESIGN: Markov cohort simulation model based on published literature from a healthcare sector perspective over a lifetime horizon. SETTING:...

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Autor principal: Ito, Kouta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129093/
https://www.ncbi.nlm.nih.gov/pubmed/30181186
http://dx.doi.org/10.1136/bmjopen-2018-022585
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author Ito, Kouta
author_facet Ito, Kouta
author_sort Ito, Kouta
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description OBJECTIVE: To evaluate the cost-effectiveness of routine administration of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA. DESIGN: Markov cohort simulation model based on published literature from a healthcare sector perspective over a lifetime horizon. SETTING: Nursing homes. PARTICIPANTS: A hypothetical cohort of nursing home residents aged 85 years with osteoporosis. INTERVENTIONS: Two strategies were compared: (1) a single intravenous dose of zoledronic acid 5 mg and (2) usual care (supplementation of calcium and vitamin D only). PRIMARY AND SECONDARY OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER), as measured by cost per quality-adjusted life year (QALY) gained. RESULTS: Compared with usual care, zoledronic acid had an ICER of $207 400 per QALY gained and was not cost-effective at a conventional willingness-to-pay threshold of $100 000 per QALY gained. The results were robust to a reasonable range of assumptions about incidence, mortality, quality-of-life effects and the cost of hip fracture and the cost of zoledronic acid. Zoledronic acid had a potential to become cost-effective if a fracture risk reduction with zoledronic acid was higher than 23% or if 6-month mortality in nursing home residents was lower than 16%. Probabilistic sensitivity analysis showed that the zoledronic acid would be cost-effective in 14%, 27% and 44% of simulations at willingness-to-pay thresholds of $50 000, $100 000 or $200 000 per QALY gained, respectively. CONCLUSIONS: Routine administration of single-dose zoledronic acid in nursing home residents with osteoporosis is not a cost-effective use of resources in the USA but could be justifiable in those with a favourable life expectancy.
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spelling pubmed-61290932018-09-10 Cost-effectiveness of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA Ito, Kouta BMJ Open Geriatric Medicine OBJECTIVE: To evaluate the cost-effectiveness of routine administration of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA. DESIGN: Markov cohort simulation model based on published literature from a healthcare sector perspective over a lifetime horizon. SETTING: Nursing homes. PARTICIPANTS: A hypothetical cohort of nursing home residents aged 85 years with osteoporosis. INTERVENTIONS: Two strategies were compared: (1) a single intravenous dose of zoledronic acid 5 mg and (2) usual care (supplementation of calcium and vitamin D only). PRIMARY AND SECONDARY OUTCOME MEASURES: Incremental cost-effectiveness ratio (ICER), as measured by cost per quality-adjusted life year (QALY) gained. RESULTS: Compared with usual care, zoledronic acid had an ICER of $207 400 per QALY gained and was not cost-effective at a conventional willingness-to-pay threshold of $100 000 per QALY gained. The results were robust to a reasonable range of assumptions about incidence, mortality, quality-of-life effects and the cost of hip fracture and the cost of zoledronic acid. Zoledronic acid had a potential to become cost-effective if a fracture risk reduction with zoledronic acid was higher than 23% or if 6-month mortality in nursing home residents was lower than 16%. Probabilistic sensitivity analysis showed that the zoledronic acid would be cost-effective in 14%, 27% and 44% of simulations at willingness-to-pay thresholds of $50 000, $100 000 or $200 000 per QALY gained, respectively. CONCLUSIONS: Routine administration of single-dose zoledronic acid in nursing home residents with osteoporosis is not a cost-effective use of resources in the USA but could be justifiable in those with a favourable life expectancy. BMJ Publishing Group 2018-09-04 /pmc/articles/PMC6129093/ /pubmed/30181186 http://dx.doi.org/10.1136/bmjopen-2018-022585 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Geriatric Medicine
Ito, Kouta
Cost-effectiveness of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA
title Cost-effectiveness of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA
title_full Cost-effectiveness of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA
title_fullStr Cost-effectiveness of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA
title_full_unstemmed Cost-effectiveness of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA
title_short Cost-effectiveness of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA
title_sort cost-effectiveness of single-dose zoledronic acid for nursing home residents with osteoporosis in the usa
topic Geriatric Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129093/
https://www.ncbi.nlm.nih.gov/pubmed/30181186
http://dx.doi.org/10.1136/bmjopen-2018-022585
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