Base-case results from the probabilistic sensitivity analysis for QFracture

Sarah Davis; Marrissa Martyn-St James; Jean Sanderson; John Stevens; Edward Goka; Andrew Rawdin; Susi Sadler; Ruth Wong; Fiona Campbell; Matt Stevenson; Mark Strong; Peter Selby; Neil Gittoes

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Davis S, Martyn-St James M, Sanderson J, et al. A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures. Southampton (UK): NIHR Journals Library; 2016 Oct. (Health Technology Assessment, No. 20.78.)

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A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures.

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Appendix 9Base-case results from the probabilistic sensitivity analysis for QFracture

TABLE 64

Base-case results from 200,000 PSA samples for QFracture risk category 1

Treatment strategy	Mean outcomes (discounted)		Incremental outcomes vs. no treatment (discounted)		ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
Treatment strategy	Cost (£)	QALYs	Cost (£)	QALYs	ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
No treatment	827.18	15.88153	0.00	0.00000	NA	316,803	475,619	NA
Ibandronic acid (oral)	834.63	15.88164	7.45	0.00011	67,340	316,798	475,615	67,340
Alendronic acid	835.01	15.88164	7.83	0.00011	68,204	316,798	475,614	91,325
Risedronic acid	835.96	15.88157	8.78	0.00004	219,757	316,795	475,611	Dominated
Ibandronic acid (i.v.)	1053.14	15.88123	225.96	–0.00030	–757,885	316,571	475,384	Dominated
Zoledronic acid	1385.41	15.88196	558.24	0.00043	1,301,875	316,254	475,073	1,752,783

: NA, not applicable.
a: ICER vs. next least costly non-dominated strategy.

TABLE 65

Base-case results from 200,000 PSA samples for QFracture risk category 2

Treatment strategy	Mean outcomes (discounted)		Incremental outcomes vs. no treatment (discounted)		ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
Treatment strategy	Cost (£)	QALYs	Cost (£)	QALYs	ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
No treatment	1532.33	14.74097	0.00	0.00000	NA	293,287	440,697	NA
Ibandronic acid (oral)	1539.62	14.74105	7.29	0.00008	96,451	293,281	440,692	Extendedly dominated
Alendronic acid	1540.17	14.74108	7.84	0.00010	76,943	293,281	440,692	Extendedly dominated
Risedronic acid	1540.77	14.74110	8.44	0.00013	65,692	293,281	440,692	65,692
Ibandronic acid (i.v.)	1757.78	14.74075	225.45	–0.00023	–997,490	293,057	440,465	Dominated
Zoledronic acid	2088.19	14.74166	555.86	0.00068	813,849	292,745	440,162	987,243

: NA, not applicable.
a: ICER vs. next least costly non-dominated strategy.

TABLE 66

Base-case results from 200,000 PSA samples for QFracture risk category 3

Treatment strategy	Mean outcomes (discounted)		Incremental outcomes vs. no treatment (discounted)		ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
Treatment strategy	Cost (£)	QALYs	Cost (£)	QALYs	ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
No treatment	2971.75	13.55783	0.00	0.00000	NA	268,185	403,763	NA
Risedronic acid	2977.17	13.55813	5.42	0.00030	17,906	268,185	403,767	17,906
Alendronic acid	2979.29	13.55813	7.54	0.00030	24,867	268,183	403,765	Extendedly dominated
Ibandronic acid (oral)	2979.64	13.55808	7.89	0.00025	31,440	268,182	403,763	Dominated
Ibandronic acid (i.v.)	3196.69	13.55889	224.94	0.00106	213,067	267,981	403,570	291,495
Zoledronic acid	3520.69	13.55932	548.94	0.00150	367,160	267,666	403,259	737,415

: NA, not applicable.
a: ICER vs. next least costly non-dominated strategy.

TABLE 67

Base-case results from 200,000 PSA samples for QFracture risk category 4

Treatment strategy	Mean outcomes (discounted)		Incremental outcomes vs. no treatment (discounted)		ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY	Incremental analysis^a (£)
Treatment strategy	Cost (£)	QALYs	Cost (£)	QALYs	ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY	Incremental analysis^a (£)
No treatment	3881.90	12.32917	0.00	0.00000	NA	242,702	365,993	NA
Alendronic acid	3886.67	12.32946	4.77	0.00028	16,820	242,702	365,997	16,820
Ibandronic acid (oral)	3888.83	12.32930	6.93	0.00012	55,519	242,697	365,990	Dominated
Risedronic acid	3889.93	12.32945	8.02	0.00027	29,255	242,699	365,994	Dominated
Ibandronic acid (i.v.)	4106.75	12.32927	224.84	0.00009	2,444,347	242,479	365,771	Dominated
Zoledronic acid	4436.61	12.33057	554.71	0.00140	397,032	242,175	365,481	493,762

: NA, not applicable.
a: ICER vs. next least costly non-dominated strategy.

TABLE 68

Base-case results from 200,000 PSA samples for QFracture risk category 5

Treatment strategy	Mean outcomes (discounted)		Incremental outcomes vs. no treatment (discounted)		ICER vs. no treatment (£)	Net benefit at £20,000 per QALY	Net benefit at £30,000 per QALY	Incremental analysis^a (£)
Treatment strategy	Cost (£)	QALYs	Cost (£)	QALYs	ICER vs. no treatment (£)	Net benefit at £20,000 per QALY	Net benefit at £30,000 per QALY	Incremental analysis^a (£)
No treatment	4052.25	11.42224	0.00	0.00000	NA	224,393	338,615	NA
Alendronic acid	4059.38	11.42235	7.13	0.00010	68,244	224,388	338,611	68,244
Ibandronic acid (oral)	4060.12	11.42216	7.86	–0.00008	–98,972	224,383	338,605	Dominated
Risedronic acid	4065.83	11.42228	13.58	0.00003	415,596	224,380	338,602	Dominated
Ibandronic acid (i.v.)	4276.53	11.42247	224.28	0.00022	997,367	224,173	338,398	Extendedly dominated
Zoledronic acid	4604.88	11.42422	552.63	0.00198	279,227	223,880	338,122	290,988

: NA, not applicable.
a: ICER vs. next least costly non-dominated strategy.

TABLE 69

Base-case results from 200,000 PSA samples for QFracture risk category 6

Treatment strategy	Mean outcomes (discounted)		Incremental outcomes vs. no treatment (discounted)		ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
Treatment strategy	Cost (£)	QALYs	Cost (£)	QALYs	ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
No treatment	4371.39	10.40268	0.00	0.00000	NA	203,682	307,709	NA
Alendronic acid	4374.47	10.40301	3.08	0.00032	9468	203,686	307,716	9468
Risedronic acid	4378.91	10.40296	7.52	0.00028	27,166	203,680	307,710	Dominated
Ibandronic acid (oral)	4379.07	10.40298	7.67	0.00029	26,208	203,680	307,710	Dominated
Ibandronic acid (i.v.)	4603.74	10.40323	232.35	0.00055	421,634	203,461	307,493	Extendedly dominated
Zoledronic acid	4916.96	10.40474	545.57	0.00206	265,440	203,178	307,225	313,498

: NA, not applicable.
a: ICER vs. next least costly non-dominated strategy.

TABLE 70

Base-case results from 200,000 PSA samples for QFracture risk category 7

Treatment strategy	Mean outcomes (discounted)		Incremental outcomes vs. no treatment (discounted)		ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY	Incremental analysis^a (£)
Treatment strategy	Cost (£)	QALYs	Cost (£)	QALYs	ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY	Incremental analysis^a (£)
Risedronic acid	4584.47	9.38541	–0.57	0.00047	–1213	183,124	276,978	NA
Alendronic acid	4584.52	9.38539	–0.52	0.00045	–1152	183,123	276,977	Dominated
No treatment	4585.04	9.38494	0.00	0.00000	NA	183,114	276,963	Dominated
Ibandronic acid (oral)	4590.32	9.38526	5.28	0.00032	16,705	183,115	276,967	Dominated
Ibandronic acid (i.v.)	4806.39	9.38577	221.35	0.00083	267,841	182,909	276,767	Extendedly dominated
Zoledronic acid	5136.10	9.38814	551.06	0.00320	172,324	182,627	276,508	202,041

: NA, not applicable.
a: ICER vs. next least costly non-dominated strategy.

TABLE 71

Base-case results from 200,000 PSA samples for QFracture risk category 8

Treatment strategy	Mean outcomes (discounted)		Incremental outcomes vs. no treatment (discounted)		ICER vs. no treatment	Net benefit at £20,000 per QALY	Net benefit at £30,000 per QALY	Incremental analysis^a (£)
Treatment strategy	Cost (£)	QALYs	Cost	QALYs	ICER vs. no treatment	Net benefit at £20,000 per QALY	Net benefit at £30,000 per QALY	Incremental analysis^a (£)
Risedronic acid	5603.84	8.33619	–4.24	0.00067	–6287	161,120	244,482	NA
Alendronic acid	5607.53	8.33657	–0.55	0.00106	–515	161,124	244,490	9563
No treatment	5608.08	8.33551	0.00	0.00000	NA	161,102	244,457	Dominated
Ibandronic acid (oral)	5616.53	8.33618	8.45	0.00066	12,715	161,107	244,469	Dominated
Ibandronic acid (i.v.)	5837.84	8.33648	229.77	0.00097	237,905	160,892	244,256	Dominated
Zoledronic acid	6157.62	8.33899	549.54	0.00348	157,893	160,622	244,012	227,376

: NA, not applicable.
a: ICER vs. next least costly non-dominated strategy.

TABLE 72

Base-case results from 200,000 PSA samples for QFracture risk category 9

Treatment strategy	Mean outcomes (discounted)		Incremental outcomes vs. no treatment (discounted)		ICER vs. no treatment	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
Treatment strategy	Cost (£)	QALYs	Cost (£)	QALYs	ICER vs. no treatment	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
Alendronic acid	8678.06	6.51525	–10.66	0.00114	–9322	121,627	186,780	NA
Risedronic acid	8680.76	6.51549	–7.97	0.00138	n5791	121,629	186,784	11,621
Ibandronic acid (oral)	8688.18	6.51507	–0.54	0.00096	–563	121,613	186,764	Dominated
No treatment	8688.72	6.51411	0.00	0.00000	NA	121,594	186,735	Dominated
Ibandronic acid (i.v.)	8902.45	6.51557	213.72	0.00146	146,407	121,409	186,565	Extendedly dominated
Zoledronic acid	9221.00	6.51944	532.28	0.00533	99,907	121,168	186,362	136,695

: NA, not applicable.
a: ICER vs. next least costly non-dominated strategy.

TABLE 73

Base-case results from 200,000 PSA samples for QFracture risk category 10

Treatment strategy	Mean outcomes (discounted)		Incremental outcomes vs. no treatment (discounted)		ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
Treatment strategy	Cost (£)	QALYs	Cost (£)	QALYs	ICER vs. no treatment (£)	Net benefit at £20,000 per QALY (£)	Net benefit at £30,000 per QALY (£)	Incremental analysis^a (£)
Risedronic acid	19,576.95	4.01080	–17.24	0.00118	–14,610	60,639	100,747	NA
Alendronic acid	19,587.52	4.01086	–6.67	0.00124	–5,392	60,630	100,738	188,505
No treatment	19,594.19	4.00962	0.00	0.00000	NA	60,598	100,695	Dominated
Ibandronic acid (oral)	19,624.63	4.01018	30.44	0.00055	54,995	60,579	100,681	Dominated
Ibandronic acid (i.v.)	19,840.81	4.01059	246.62	0.00096	255,998	60,371	100,477	Dominated
Zoledronic acid	20,137.69	4.01250	543.50	0.00288	189,028	60,112	100,237	335,702

: NA, not applicable.
a: ICER vs. next least costly non-dominated strategy.

Copyright © Queen’s Printer and Controller of HMSO 2016. This work was produced by Davis et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

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Davis S, Martyn-St James M, Sanderson J, et al. A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures. Southampton (UK): NIHR Journals Library; 2016 Oct. (Health Technology Assessment, No. 20.78.) Appendix 9, Base-case results from the probabilistic sensitivity analysis for QFracture.
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