Cost-utility of drug treatment in the secondary prevention of fragility fractures: a regional study

Objectives

Fractures due to bone fragility are a major cause of morbidity and mortality. This study aimed to assess the cost-effectiveness of secondary prevention of these fractures using real-world data from the Basque population.

Methods

A retrospective observational study was conducted, including individuals aged 60 years and over with fragility fractures of the wrist, humerus or vertebrae. The study used a cost-effectiveness design, incorporating individual-level data on costs and quality-adjusted life years (QALYs). The two groups were balanced using a propensity score (entropy balance). Both the study follow-up period and the patient’s entire lifetime were analysed. The latter was obtained by adding comorbidity-adjusted life expectancy to the follow-up period via extrapolation based on survival analysis. The incremental cost-effectiveness ratio (ICER) was calculated for each group, and variability was analysed using bootstrapping, cost-effectiveness plots and acceptability curves. The incremental net benefit was also calculated using regression models.

Results

A total of 33,569 patients were included in the study, of whom 12,833 had wrist fractures, 12,586 had vertebral fractures and 8,150 had fractures of the humerus. Of these patients, 20.12% were treated, with different percentages for vertebral (32.34%), wrist (14.46%) and humerus (10.17%) cases. The incremental cost-effectiveness ratio following the use of the propensity score was €720 per QALY gained over the follow-up period, and €270 per QALY gained when extrapolated. Similar results were obtained from the bootstrapping and incremental net benefit analyses.

Discussion

The ICER for the three types of fracture analysed is well below Spain’s defined acceptability threshold of around €23,000/QALY. This implies that secondary prevention should continue as a public health policy, with efforts being made to increase the proportion of patients treated.

Key messages

• Secondary prevention of fragility fractures is a cost-effective public health policy.

• More effort should be made to increase the proportion of patients who are treated.