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Osteoporosis International
Published in: Osteoporosis International 7/2018

01-07-2018 | Position Paper

Cost-effective but clinically inappropriate: new NICE intervention thresholds in osteoporosis (Technology Appraisal 464)

Authors: N. C. Harvey, E. McCloskey, J. A. Kanis, J. Compston, C. Cooper

Published in: Osteoporosis International | Issue 7/2018

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Abstract

Purpose

To comment on the latest technology appraisal of the National Institute for Clinical Excellence (NICE) in osteoporosis.

Methods

Review of NICE Technology Appraisal (TA464) on bisphosphonate use in osteoporosis.

Results

The NICE appraisal on bisphosphonate use in osteoporosis indicates that treatment with oral bisphosphonates may be instituted at a FRAX 10-year probability of major osteoporotic fracture above 1%. Implementation would mean that all women aged 50 years or older are deemed eligible for treatment, a position that would increase the burden of rare long-term side effects across the population.

Conclusion

Cost-effectiveness thresholds for low-cost interventions should not be used to set intervention thresholds but rather to validate the implementation of clinically driven intervention thresholds.
Literature
1.
NICE (2017) TA464: bisphosphonates for treating osteoporosis. National Institute for Health and Care Excellence, London
2.
3.
NICE (2008) TA160: alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women (amended). National Institute for Health and Care Excellence, London
4.
NICE (2008) TA161: alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. National Institute for Health and Care Excellence, London
5.
Kanis JA, McCloskey E, Jonsson B, Cooper A, Strom O, Borgstrom F (2010) An evaluation of the NICE guidance for the prevention of osteoporotic fragility fractures in postmenopausal women. Arch Osteoporos 5:19–48CrossRef
6.
NICE (2012) CG146: osteoporosis: fragility fracture risk. Short clinical guideline- evidence and recommendation, National Clinical Guideline Centre, London
7.
McCloskey E, Kanis JA, Johansson H, Harvey N, Oden A, Cooper A, Cooper C, Francis RM, Reid DM, Marsh D, Selby P, Thompson F, Hewitt S, Compston J (2015) FRAX-based assessment and intervention thresholds—an exploration of thresholds in women aged 50 years and older in the UK. Osteoporos Int 26(8):2091–2099. https://​doi.​org/​10.​1007/​s00198-015-3176-0 CrossRefPubMed
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9.
Rizzoli R, Akesson K, Bouxsein M, Kanis JA, Napoli N, Papapoulos S, Reginster JY, Cooper C (2011) Subtrochanteric fractures after long-term treatment with bisphosphonates: a European society on clinical and economic aspects of osteoporosis and osteoarthritis, and international osteoporosis foundation working group report. Osteoporos Int 22(2):373–390. https://​doi.​org/​10.​1007/​s00198-010-1453-5 CrossRefPubMed
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Adler RA, El-Hajj Fuleihan G, Bauer DC, Camacho PM, Clarke BL, Clines GA, Compston JE, Drake MT, Edwards BJ, Favus MJ, Greenspan SL, McKinney R Jr, Pignolo RJ, Sellmeyer DE (2016) Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 31(1):16–35. https://​doi.​org/​10.​1002/​jbmr.​2708 CrossRefPubMedPubMedCentral
11.
Kanis JA, Adams J, Borgstrom F, Cooper C, Jonsson B, Preedy D, Selby P, Compston J (2008) The cost-effectiveness of alendronate in the management of osteoporosis. Bone 42(1):4–15CrossRefPubMed
12.
Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A (2008) Case finding for the management of osteoporosis with FRAX—assessment and intervention thresholds for the UK. Osteoporos Int 19(10):1395–1408CrossRefPubMed
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Metadata
Title
Cost-effective but clinically inappropriate: new NICE intervention thresholds in osteoporosis (Technology Appraisal 464)
Authors
N. C. Harvey
E. McCloskey
J. A. Kanis
J. Compston
C. Cooper
Publication date
01-07-2018
Publisher
Springer London
Published in
Osteoporosis International / Issue 7/2018
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-018-4505-x

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