Health and Spending Consequences of Bisphosphonate Treatment for Osteoporosis: A Markov Model Approach

Osteoporosis-related hip fractures are a major source of avoidable disability and generate significant healthcare costs.  Although bisphosphonates use has been shown to prevent osteoporotic fractures, utilization has been low. This study assessed the value of bisphosphonates to patients and payers by estimating the health and spending consequences of treatment.  We ran Markov models to assess the effects of bisphosphonate treatment on hip fractures, long-term-care (LTC) facility admissions, life years, and medical and custodial care spending for females aged 65 and 75 with mild, moderate, and severe osteoporosis. Assumptions were developed using 2011-2013 Medicare claims, a mixed-effect meta-analysis of prior clinical studies, and literature review. For females age 75 with a high risk of osteoporotic hip fracture, bisphosphonate treatment would result in 4,965 fewer hip fractures per 100,000 people; and 2,982 avoided LTC admissions per 100,000 people. Over a 75 year old woman’s lifetime, bisphosphonate treatment decreases expected medical services spending ($US 2012) for hip fracture between $640 (mild risk) and $2,006 (high risk) (p<.05) and LTC spending by $1,785 (mild risk) and $5,816 (high risk) (p < .05). Despite the value of bisphosphonates to patients, their utilization remains low due, in part, to lack of patient education and insurance restrictions on injectable bisphosphonates. Increased utilization of bisphosphonate would reduce fractures and generate significant offsets to spending on bisphosphonates.

Link to report:  Consequences of Bisphosphonate Treatment

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