Background/Purpose:

The aim of the present study was to identify the FRAX®Port (FRAX® validated for Portugal) ten-year major and hip osteoporotic fracture probabilities, above which pharmacologic interventions become cost effective in the Portuguese context. 

Methods:

A previously developed and validated state transition Markov cohort model was populated with epidemiologic, economic and quality-of-life fracture data from Portugal. Cost-effective FRAX-based intervention thresholds for generic alendronate, zoledronic acid, denosumab and teriparatide when compared to “no intervention” were calculated assuming a willingness to pay of €32,000 (2 times national Gross Domestic Product per capita) per QALY (Quality-Adjusted Life Years).

Results:

In the Portuguese epidemiological and economic context, treatment with generic alendronate is cost-effective for people aged 50+, presenting 10-year probabilities (FRAX®Port) at or above 8.8% for major osteoporotic fractures and 2.5% for hip fractures. These values increase to 20.4% and 10.1% for zoledronic acid, 34.9% and 10.1% for denosumab and to 77.8% and 62.6% to teriparatide for major osteoporotic and hip fractures respectively. A tool is provided to perform the calculation of cost-effective intervention thresholds for different medications, according to age group and diverse levels of willingness to pay (WTP).

Conclusion:

Cost-effective intervention thresholds, for different medications, age-groups and WTP,  based on 10-year probabilities of major and hip fracture probabilities calculated with FRAX®Port are provided.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cost-effective-osteoporosis-treatment-intervention-thresholds-based-on-frax-in-portugal/