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Guthrie B, Rogers G, Livingstone S, et al. The implications of competing risks and direct treatment disutility in cardiovascular disease and osteoporotic fracture: risk prediction and cost effectiveness analysis. Southampton (UK): National Institute for Health and Care Research; 2024 Feb. (Health and Social Care Delivery Research, No. 12.04.)
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The implications of competing risks and direct treatment disutility in cardiovascular disease and osteoporotic fracture: risk prediction and cost effectiveness analysis.
Show detailsSupplementary methods
Accounting for competing risk of non-cardiovascular death
As explained in the main text (see Accounting for competing risk of non-cardiovascular death, p.91), the critical covariate for our relative survival models is Δlogit(Q), that is the difference between an individual’s predicted 10-year QFracture-2012 score and the average score for a person of the same age and sex. We estimate the latter using a regression on the CPRD data set. Table 57 shows the model coefficients and Figure 61 shows the model fitted for men and women as a function of age.
TABLE 57
Regression estimating population average logit(QFracture-2012 10-year risk of MOF) as a function of sex and age
![FIGURE 61. Average 10-year risk of MOF (QFracture-2012) as a function of age and sex.](/books/NBK601048/bin/15-12-22_fig61.gif)
FIGURE 61
Average 10-year risk of MOF (QFracture-2012) as a function of age and sex.
Supplementary results
Threshold at which treatment becomes associated with positive net benefit according to the generalised additive model adjusting for age and fracture risk
The threshold at which treatment becomes associated with positive net benefit according to the GAM and adjusting for age and fracture risk is shown in Table 58.
TABLE 58
Outputs of the GAM, adjusting for age and fracture risk: threshold at which alendronate becomes cost-effective compared with no treatment
Cost-effectiveness of bisphosphonates for the primary prevention of osteoporotic fragility fracture: meta-model accounting for age, sex and baseline fracture risk
The meta-model takes the form:
Figure 62 shows the fitted model for men and women at indicative ages of 50, 60, 70 and 80 years, and Table 59 tabulates the threshold at which net benefit becomes positive (assuming that decision-makers value QALYs at £20,000 each).
TABLE 59
Outputs of GAM, adjusting for age, sex and fracture risk: threshold at which alendronate becomes cost-effective compared with no treatment
- Supplementary methods and results for model assessing cost-effectiveness of bisp...Supplementary methods and results for model assessing cost-effectiveness of bisphosphonates for the primary prevention of osteoporotic fragility fracture - The implications of competing risks and direct treatment disutility in cardiovascular disease and osteoporotic fracture: risk prediction and cost effectiveness analysis
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