Economic Analysis of Bisphosphonate Use after Distal Radius Fracture for Prevention of Hip Fracture

Document Type : RESEARCH PAPER

Authors

Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA

Abstract

Background: Osteoporosis is a common condition among the elderly population, and is associated with an increased risk of fracture. One of the most common fragility fractures involve the distal radius, and are associated with risk of subsequent fragility fracture. Early treatment with bisphosphonates has been suggested to decrease the population hip fracture burden. However, there have been no prior economic evaluations of the routine treatment of distal radius fracture patients with bisphosphonates, or the implications on hip fracture rate reduction. Methods: Age specific distal radius fracture incidence, age specific hip fracture rates after distal radius fracture with and without risendronate treatment, cost of risendronate treatment, risk of atypical femur fracture with bisphosphonate treatment, and cost of hip fracture treatment were obtained from the literature. A unique stochastic Markov chain decision tree model was constructed from derived estimates. The results were evaluated with comparative statistics, and a one-way threshold analysis performed to identify the break-even cost of bisphosphonate treatment. Results: Routine treatment of the current population of all women over the age of 65 suffering a distal radius fracture with bisphosphonates would avoid 94,888 lifetime hip fractures at the cost of 19,464 atypical femur fractures and $19,502,834,240, or on average $2,186,617,527 annually, which translates to costs of $205,534 per hip fracture avoided. The breakeven price point of annual bisphosphonate therapy after distal radius fracture for prevention of hip fractures would be approximately $70 for therapy annually. Conclusion: Routine treatment of all women over 65 suffering distal radius fracture with bisphosphonates would result in a significant reduction in the overall hip fracture burden, however at a substantial cost of over a $2 billion dollars annually. To optimize efficiency of treatment either patients may be selectively treated, or the cost of annual bisphosphonate treatment should be reduced to cost-effective margins.

Keywords

Main Subjects


1. Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL,
Wahner HW, Dunn WL, et al. Prevalence of low femoral
bone density in older U.S. adults from NHANES III. J
Bone Miner Res. 1997; 12(11):1761–8.
2. Cauley JA. Public health impact of osteoporosis. J
Gerontol A Biol Sci Med Sci. 2013; 68(10):1243–51.
3. Dempster DW. Osteoporosis and the burden of
osteoporosis-related fractures. Am J Manag Care.
2011; 17(Suppl 6):S164–9.
4. Svedbom A, Ivergård M, Hernlund E, Rizzoli R,
Kanis JA. Epidemiology and economic burden of
osteoporosis in Switzerland. Arch Osteoporos. 2014;
9(1):187.
5. Mallmin H, Ljunghall S, Persson I, Bergström R.
Risk factors for fractures of the distal forearm: a
population-based case-control study. Osteoporos Int.
1994; 4(6):298–304.
6. Bergström U, Björnstig U, Stenlund H, Jonsson H,
Svensson O. Fracture mechanisms and fracture
pattern in men and women aged 50 years and older:
a study of a 12-year population-based injury register,
Umeå, Sweden. Osteoporos Int. 2008; 19(9):1267–73.
7. Chen CW, Huang TL, Su LT, Kuo YC, Wu SC, Li CY, et al.
Incidence of subsequent hip fractures is significantly
increased within the first month after distal radius
fracture in patients older than 60 years. J Trauma
Acute Care Surg. 2013; 74(1):317–21.
8. Freedman BA, Potter BK, Nesti LJ, Cho T, Kuklo TR.
Missed opportunities in patients with osteoporosis
and distal radius fractures. Clin Orthop Relat Res.
2007; 454(4):202–6.
9. Haentjens P, Autier P, Collins J, Velkeniers B,
Vanderschueren D, Boonen S. Colles fracture, spine
fracture, and subsequent risk of hip fracture in men
and women. A meta-analysis. J Bone Joint Surg Am.
2003; 85-A(10):1936–43.
10. Hodsman AB, Leslie WD, Tsang JF, Gamble GD. 10-year
probability of recurrent fractures following wrist and
other osteoporotic fractures in a large clinical cohort:
an analysis from the Manitoba Bone Density Program.
Arch Intern Med. 2008; 168(20):2261–7.
11. Schousboe JT, Fink HA, Taylor BC, Stone KL, Hillier TA,
Nevitt MC, et al. Association between self-reported
prior wrist fractures and risk of subsequent hip and
radiographic vertebral fractures in older women: a
prospective study. J Bone Miner Res. 2005; 20(1):100–6.
12. Tosteson AN, Burge RT, Marshall DA, Lindsay R.
Therapies for treatment of osteoporosis in US women:
cost-effectiveness and budget impact considerations.
Am J Manag Care. 2008; 14(9):605–15.
13. Wells G, Cranney A, Peterson J, Joucher M, Shea B,
Robinson V, et al. Risedronate for the primary and
secondary prevention of osteoporotic fractures in
postmenopausal women. Cochrane Database Syst Rev.
2008; 23(1):CD004523.
14. Sim IW, Ebeling PR. Treatment of osteoporosis in men
with bisphosphonates: rationale and latest evidence.
Ther Adv Musculoskelet Dis. 2013; 5(5):259–67.
15. Hopkins RB, Goeree R, Pullenayegum E, Adachi JD,
Papaioannou A, Xie F, et al. The relative efficacy of
nine osteoporosis medications for reducing the
rate of fractures in post-menopausal women. BMC
Musculoskelet Disord. 2011; 12(1):209.
16. Fleurence RL, Iglesias CP, Johnson JM. The cost
effectiveness of bisphosphonates for the prevention
and treatment of osteoporosis: a structured review
of the literature. Pharmacoeconomics. 2007;
25(11):913–33.
17. Black DM, Cummings SR, Karpf DB, Cauley JA,
Thompson DE, Nevitt MC, et al. Randomised trial of
effect of alendronate on risk of fracture in women with
existing vertebral fractures. Fracture Intervention Trial
Research Group. Lancet. 1996; 348(9041):1535–41.
18. Edwards BJ, Koval K, Bunta AD, Genuario K, Hahr A,
Andruszyn L, et al. Addressing secondary prevention
of osteoporosis in fracture care: follow-up to “own the
bone.”J Bone Joint Surg Am. 2011; 93(15):e87.
19. Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE.
Practice patterns in the diagnosis and treatment of
osteoporosis after a fragility fracture: a systematic
review. Osteoporos Int. 2004; 15(10):767–78.
20. Thompson M, Pasquale M, Grima D, Moehrke W, Kruse
HP. The impact of fewer hip fractures with risedronate
versus alendronate in the first year of treatment:
modeled German cost-effectiveness analysis. Value
Health. 2010; 13(1):46–54.
21. Freedman KB, Kaplan FS, Bilker WB, Strom BL,
Lowe RA. Treatment of osteoporosis: are physicians
missing an opportunity? J Bone Joint Surg Am. 2000;
82-A(8):1063–70.
22. Naimark D, Krahn MD, Naglie G, Redelmeier DA,
Detsky AS. Primer on medical decision analysis:
Part 5-Working with Markov processes. Med Decis
Making.1997; 17(2):152–9.
23. Detsky AS, Naglie G, Krahn MD, Redelmeier DA,
Naimark D. Primer on medical decision analysis:
Part 2-Building a tree. Med Decis Making. 1997;
17(2):126–35.
24. Krahn MD, Naglie G, Naimark D, Redelmeier DA,
Detsky AS. Primer on medical decision analysis: part
4--analyzing the model and interpreting the results.
Med Decis Making.1997; 17(2):142–51.
25. Wilcke MKT, Hammarberg H, Adolphson PY.
Epidemiology and changed surgical treatment
methods for fractures of the distal radius: a registry
analysis of 42,583 patients in Stockholm County,
Sweden, 2004–2010. Acta Orthop. 2013; 84(3):292–6.
26. Adams AL, Shi J, Takayanagi M, Dell RM, Funahashi
TT, Jacobsen SJ. Ten-year hip fracture incidence rate
trends in a large California population, 1997-2006.
Osteoporos Int. 2013; 24(1):373–6.
27. Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker
GA, Gunraj N, Austin PC, et al. Bisphosphonate use and
the risk of subtrochanteric or femoral shaft fractures
in older women. JAMA. 2011; 305(8):783-9.
28. Annual Estimates of the resident population for
selected age groups by sex for the United States,
States, Counties, and Puerto Rico Commonwealth
and Municipios: 2012 Population Estimates. United
State Census Bureau. Available at: URL: https://
factfinder.census.gov/faces/tableservices/jsf/pages/
productview.xhtml?src=bkmk; 2012.
29. Gedmintas L, Solomon DH, Kim SC. Bisphosphonates
and risk of subtrochanteric, femoral shaft, and atypical
femur fracture: a systematic review and meta-analysis.
J Bone Miner Res. 2013; 28(8):1729–37.
30. Pazianas M, Abrahamsen B, Wang Y, Russell RG.
Incidence of fractures of the femur, including
subtrochanteric, up to 8 years since initiation of oral
bisphosphonate therapy: a register-based cohort
study using the US MarketScan claims databases.
Osteoporos Int. 2012; 23(12):2873–84.