5th NHPRC

1

• 5th NHPRC
• Esbjerg, June 16, 2006
• Economic evaluation of an elderly safety
  promotion intervention
• Pia Johansson with
• Stockholm Centre for Public Health Per Tillgren
• Stockholm County Council Siv Sadigh
• Sweden Antonio Ponce de Leon
• pia.m.johansson_at_sll.se

2
Cost-effectiveness analysis

• intervention costs
• If intervention is successful
• costs avoided
• health effects
• cost per health

Cost-effective decision-makers are willing to pay
3
Intervention costs
7.9 million SEK
4
Successful intervention?
Effect evaluation Quasi-experimental 6 control
groups Time series Pre-intervention period
1990-95 Intervention 1996-2001 (1999) 2 age
groups 65-80 y and 80 Men and women
No pattern!
5
Successful intervention!
Statistical analysis Decreases in most ages,
genders and areas Taking in account differences
in level of rate (contextual factors) in
pre-intervention period Decreases in hip
fractures for Men 65-80 Men 80 Women
65-80 But Increases for women 80 Net result
14 avoided hip fractures
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Costs avoided and health effects

• During the first year after a hip fracture
• Costs avoided 130,000 SEK
• Health losses avoided 0.17 QALYs
• 14 avoided hip fractures 1,820,000 SEK and 2.38
  QALYs
• cost per health of 2.6 million SEK per QALY
• Not cost-effective!
• As decision-maker value of a QALY approx. 500,000
  SEK

Borgström F, Zethraeus N, Johnell O, Lidgren L,
Ponzer S, Svensson O, Abdon P, Ornstein E, Lunsjö
K, Thorngren K G, Sernbo I, Rehnberg C, Jönsson
B. Costs and quality of life associated with
osteoporosis-related fractures in Sweden.
Osteoporosis Int (preview).
7
Break-even analysis

• Tentative analysis
• Assuming the costs and health effects are the
  same during following years
• What is needed to become cost-effective?
• All 14 people avoid hip fracture for 3 years
• 448,000 SEK per QALY
• 3 people live another 10 years without hip
  fracture
• 518,000 SEK per QALY
• So, further analyses using health economic models
  to estimate the probable future costs and health
  losses avoided.