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. 2018 Jul;29(7):1511-1513.
doi: 10.1007/s00198-018-4505-x. Epub 2018 Jun 8.

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

N C Harvey  1   2   3 , E McCloskey  4   5 , J A Kanis  6   7 , J Compston  8 , C Cooper  1   2   3
Affiliations

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

N C Harvey et al. Osteoporos Int. 2018 Jul.

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.

Keywords: Cost-effectiveness; FRAX; Intervention thresholds; National Institute for Clinical Excellence; National Osteoporosis Guideline Group; Osteoporosis.

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References

    1. NICE. TA464: Bisphosphonates for treating osteoporosis. National Institute for Health and Care Excellence; London: 2017.
    1. Sims I. Many more eligible for bisphosphonates after NICE lowers threshold to 1% [Accessed 26/07/2017 2017];PULSE. 2017 http://www.pulsetoday.co.uk/clinical/more-clinical-areas/musculoskeletal....
    1. NICE. 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: 2008.
    1. NICE. 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: 2008.
    1. Kanis JA, McCloskey E, Jonsson B, Cooper A, Strom O, Borgstrom F. An evaluation of the NICE guidance for the prevention of osteoporotic fragility fractures in postmenopausal women. Archives of Osteoporosis. 2010;5:19–48.

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