The cost-effectiveness of osteoporosis medications for preventing periprosthetic fractures following femoral neck fracture indicated hip arthroplasty: a break-even analysis

Authors

Amil R. Agarwal, Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA.
Matthew J. Kinnard, Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Christopher Murdock, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
Amy Y. Zhao, Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA. zhaoa@gwmail.gwu.edu.
Uzoma Ahiarakwe, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
Jordan S. Cohen, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PD, USA.
Kendall F. Moseley, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
Gregory J. Golladay, Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA.
Savyasachi C. Thakkar, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.

Document Type

Journal Article

Publication Date

4-15-2024

Journal

Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA

DOI

10.1007/s00198-024-07085-6

Keywords

Bisphosphonates; Cost-effective; Osteoporosis; Periprosthetic fracture

Abstract

UNLABELLED: Osteoporosis treatment following arthroplasty for femoral neck fracture (FNF) is associated with lower rates of periprosthetic fracture (PPF). Our study evaluated the economic viability of treatment in patients following arthroplasty and demonstrates that treatment with oral bisphosphonates can be cost-effective in preventing PPF. INTRODUCTION: Osteoporosis treatment following arthroplasty for femoral neck fracture (FNF) is associated with lower rates of periprosthetic fracture (PPF). Although cost-effective in reducing the rate of secondary fragility fracture, the economic viability of osteoporosis treatment in preventing PPF has not been evaluated. Therefore, the purpose of this study is to use a break-even analysis to determine whether and which current osteoporosis medications are cost-effective in preventing PPF following arthroplasty for FNFs. METHODS: Three-year average cost of osteoporosis medication (oral bisphosphonates, estrogen hormonal therapy, intravenous (IV) bisphosphonates, denosumab, teriparatide, and abaloparatide), costs of PPF care, and PPF rates in patients who underwent hip arthroplasty for FNFs without osteoporosis treatment were used to perform a break-even analysis. The absolute risk reduction (ARR) related to osteoporosis treatment and sensitivity analyses were used to evaluate the cost-effectiveness of this intervention and break-even PPF rates. RESULTS: Oral bisphosphonate therapy following arthroplasty for hip fractures would be economically justified if it prevents one out of 56 PPFs (ARR, 1.8%). Given the current cost and incidence of PPF, overall treatment can only be economically viable for PPF prophylaxis if the 3-year costs of these agents are less than $1500. CONCLUSION: The utilization of lower cost osteoporosis medications such as oral bisphosphonates and estrogen hormonal therapy as PPF prophylaxis in this patient population would be economically viable if they reduce the PPF rate by 1.8% and 1.5%, respectively. For IV bisphosphonates and newer agents to be economically viable as PPF prophylaxis in the USA, their costs need to be significantly reduced.

APA Citation

Agarwal, Amil R.; Kinnard, Matthew J.; Murdock, Christopher; Zhao, Amy Y.; Ahiarakwe, Uzoma; Cohen, Jordan S.; Moseley, Kendall F.; Golladay, Gregory J.; and Thakkar, Savyasachi C., "The cost-effectiveness of osteoporosis medications for preventing periprosthetic fractures following femoral neck fracture indicated hip arthroplasty: a break-even analysis" (2024). GW Authored Works. Paper 4722.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4722

Department

School of Medicine and Health Sciences Student Works