Supplementary methods and results for model assessing cost-effectiveness of bisphosphonates for the primary prevention of osteoporotic fragility fracture

Bruce Guthrie; Gabriel Rogers; Shona Livingstone; Daniel R Morales; Peter Donnan; Sarah Davis; Ji Hee Youn; Rob Hainsworth; Alexander Thompson; Katherine Payne

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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.

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Appendix 9Supplementary methods and results for model assessing cost-effectiveness of bisphosphonates for the primary prevention of osteoporotic fragility fracture

Supplementary 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.

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:

\begin{array}{l} g (E [I N M B]) = β_{0} + f (Q F r a c, A g e) A d j . S e x . \end{array}

(18)

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).

$FIGURE 62. Cost-effectiveness of bisphosphonates (incremental net monetary benefit compared with no treatment) as a function of age, sex and risk of fracture, with different assumptions about competing risk of non-fracture death.$

FIGURE 62

Cost-effectiveness of bisphosphonates (incremental net monetary benefit compared with no treatment) as a function of age, sex and risk of fracture, with different assumptions about competing risk of non-fracture death. (a) Men aged 50 years; (b) women (more...)

TABLE 59

Outputs of GAM, adjusting for age, sex and fracture risk: threshold at which alendronate becomes cost-effective compared with no treatment

This work was produced by Guthrie et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/. For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited.

Bookshelf ID: NBK601048

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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.) Appendix 9, Supplementary methods and results for model assessing cost-effectiveness of bisphosphonates for the primary prevention of osteoporotic fragility fracture.
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