OTA 2013 Posters

Scientific Poster #35 Geriatric OTA 2013

Cost-Effective Analysis of an Implantable Hip Strengthening Device Compared to Bisphosphonates for Reducing Contralateral Hip Fractures in “At-Risk” Patients

Sahaja Patel, MS1; Robert L. Burden, MEng1,2; Michael J. Voor, PhD1,2 ;
1Vivorté, Inc, Louisville, Kentucky, USA;
2University of Louisville Department of Orthopaedic Surgery, Louisville, Kentucky, USA

Purpose: This study was a cost-effectiveness analysis of a proposed hip strengthening device placed contralaterally at the time of index hip fracture. The hypothesis was that the device (assumed to be either 90% or 100% effective in preventing a contralateral hip fracture due to a fall to the side) would be more economical over 10 years compared to either no treatment or bisphosphonate therapy.

Methods: The cost-effectiveness was analyzed for procedures used to address secondary contralateral hip fractures following initial hip fractures. The cost per quality-adjusted life year (QALY) gained was evaluated based on health utility scores that were obtained from a review of utility values for osteoporotic health states and post–hip fracture health states. Prophylaxis intervention costs were calculated and compared to intervention costs with no treatment, treatment with pharmaceutical drugs, and a combination of drugs and the prophylactic device. Cost-utility ratios were estimated in a hypothetical cohort aged 75 years, for a period of 10 years, the “no treatment” contralateral second hip fracture rate being 12%. Total cost of intervention was inclusive of all direct costs involved; the cost of the device or drugs and other services during the treatment period such as dual-energy x-ray absorptiometry (DXA) scans, annual physician visits, etc. The average cost of the implantable device treatment (with an assumed efficacy of either 90% or 100%) was assumed to be a one-time amount of $10,000 (including device, surgeon, hospital, recovery, etc) since this fixation method will be a single surgical event. The average cost of drugs at their maximum efficacy was $1000 per year. A treatment method to prevent hip fractures is cost-effective if the additional cost per QALY gained is equal to or below a threshold value of $50,000.

Results: The results of the analysis are presented in Table 1. This evaluation confirmed the cost-effectiveness of the device over a period of 10 years, and also further implied that the device was more economical when compared to treatment with pharmaceutical drugs over only 5 years. This analysis also implied that when the device was used along with bisphosphonate drugs, the costs remained below the threshold value ($50,000) and therefore were cost-effective.

Table 1. Cost per QALY of various treatment methods to prevent hip fractures, a 2- to 10-year analysis

Conclusion: A permanently implantable device can maintain efficacy in preventing hip fractures with decreasing costs over longer time periods when compared to no treatment or treatment with bisphosphonate drugs.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.