COST-EFFECTIVENESS OF SINGLE-DOSE ZOLEDRONIC ACID FOR NURSING HOME RESIDENTS WITH OSTEOPOROSIS
Author(s)
Ito K
Hebrew SeniorLife, Dedham, MA, USA
OBJECTIVES: Hip fracture sustained in nursing homes is an important source of mortality, morbidity, and healthcare expenditure. The study aimed at evaluating the cost-effectiveness of routine administration of single-dose zoledronic acid in nursing home residents with osteoporosis. METHODS: A Markov cohort simulation model was developed. The target population was a hypothetical cohort of nursing home residents aged 85 years with osteoporosis. The analysis was conducted from a health care system perspective over a lifetime horizon. Two strategies were compared: a single intravenous dose of zoledronic acid 5mg (ZOL); and usual care (calcium and vitamin D supplementation only). Data sources were published literature. The relative risk of hip fracture was estimated based on a surrogate outcome of bone mineral density in the ZEST (Zoledronic acid in frail Elders to STrengthen bone) trial RESULTS: Compared with usual care, the ZOL strategy had an ICER of $220,300 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 administration cost of ZOL. The ZOL strategy had a potential to become cost-effective if 6-month mortality in nursing home residents was below 15% or if fracture risk reduction by ZOL was above 25%. Probabilistic sensitivity analysis revealed that the ZOL strategy would be cost-effective in 11%, 24%, and 42% 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 from a health care system perspective. It would be justifiable in nursing home residents with a favorable life expectancy.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PMS33
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Geriatrics, Musculoskeletal Disorders