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The government of Kazakhstan, a middle-income country in Central Asia, is considering the introduction of rotavirus vaccination into its national immunization program. We performed a cost-effectiveness analysis of rotavirus vaccination spanning 20 years by using a synthesis of dynamic transmission models accounting for herd protection. We found that a vaccination program with 90% coverage would prevent ≈880 rotavirus deaths and save an average of 54,784 life-years for children <5 years of age. Indirect protection accounted for 40% and 60% reduction in severe and mild rotavirus gastroenteritis, respectively. Cost per life year gained was US $18,044 from a societal perspective and US $23,892 from a health care perspective. Comparing the 2 key parameters of cost-effectiveness, mortality rates and vaccine cost at

Background: Estimating the economic impact of influenza is complicated because the disease may have nonspecific symptoms, and many patients with influenza are registered with other diagnoses. Furthermore, in some countries like Norway, employees can be on paid sick leave for a specified number of days without a doctor's certificate ("self-reported sick leave") and these sick leaves are not registered. Both problems result in gaps in the existing literature: costs associated with influenza-related illness and self-reported sick leave are rarely included. The aim of this study was to improve estimates of total influenza-related health-care costs and productivity losses by estimating these missing costs. Methods: Using Norwegian data, the weekly numbers of influenza-attributable hospital admissions and certified sick leaves registered with other diagnoses were estimated from influenza-like illness surveillance data using quasi- Poisson regression. The number of self-reported sick leaves was estimated using a Monte-Carlo simulation model of illness recovery curves based on the number of certified sick leaves. A probabilistic sensitivity analysis was conducted on the economic outcomes. Results: During the 1998/99 through 2005/06 influenza seasons, the models estimated an annual average of 2700 excess influenza-associated hospitalizations in Norway, of which 16% were registered as influenza, 51% as pneumonia and 33% were registered with other diagnoses. The direct cost of seasonal influenza totaled US$22 million annually, including costs of pharmaceuticals and outpatient services. The annual average number of working days lost was predicted at 793 000, resulting in an estimated productivity loss of US$231 million. Selfreported sick leave accounted for approximately one-third of the total indirect cost. During a pandemic, the total cost could rise to over US$800 million. Conclusions: Influenza places a considerable burden on patients and society with indirect costs greatly exceeding direct costs. The cost of influenza-attributable complications and the cost of self-reported sick leave represent a considerable part of the economic burden of influenza. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine the long-term cost-effectiveness of two reperfusion modalities in patients with acute ST-segment elevation myocardial infarction: primary percutaneous coronary intervention (PCI) versus thrombolytic therapy . Design. A state-transition model that follows patients from when they develop STEMI until they die was developed. The model encompassed events and health states. Sensitivity analyses were undertaken. Results. For a 65-year old man, life expectancy was 8.3 years with primary PCI and 7.6 years with thrombolytic therapy. The lifetime costs were €19 250 (NOK 154 000) and €29 250 (NOK 234 000), respectively, for patients living close to an invasive unit. Cost savings from PCI were mainly due to the reduction in future coronary interventions. For patients needing helicopter transport to arrive in time to an invasive unit for PCI, the costs were €24 000 (NOK 192 000) and €29 250 (NOK 234 000), respectively (all costs undiscounted). For women, the estimates were somewhat higher due to lower mortality. Conclusion . Compared with thrombolytic therapy, reperfusion by primary PCI results in greater health benefits at reduced lifetime costs. These findings may have important clinical implications in an increasing cost-conscious health care environment. [ABSTRACT FROM AUTHOR]

A sample of 3,201 Danes was subjected to personal interviews in which they were asked to state their preferences for risk-reducing health care interventions based on information on absolute risk reduction (ARR) and relative risk reduction (RRR). The aim of the study was to measure the relative weighting of different types of risk information under various circumstances. The effect of presenting questions, and of explicitly formulating RRR, was analyzed. A preference for increases in RRR was demonstrated. There was a stronger inclination to choose the intervention that offered the highest RRR if RRR was explicitly stated. Individuals with more than 10 years of schooling also demonstrated a preference for increased ARR, but only when facing individually framed choices. In a social choice context, preferences for RRR remained intact, but the magnitude of ARR had no impact on choices. Results imply that social framing may induce a propensity to prefer interventions that target high-risk populations. Those respondents who had received ≤10 years of schooling demonstrated preferences for RRR but not ARR, and no impact of social framing was observed. [ABSTRACT FROM AUTHOR]

Objective. To estimate the effect from an osteoporosis intervention in terms of postponement of hip fractures. Design. A Markov model using Nordic data on mortality and hip fracture incidence. Patients. Women aged 50 years and older with increased risk of hip fracture. Intervention. A hypothetical intervention that reduces the risk of hip fracture by 50%. Main outcome measures. Postponement of hip fractures – that is increase in expected fracture-free survival from osteoporosis interventions. Results. A 1-year treatment would on average postpone hip fracture by 12 days if therapy were started at the age of 50 years and 23, 55, 90 or 74 days if the treatment were started at the ages of 60, 70, 80 or 90 years, respectively. For 10 years of treatment, the benefit was 146, 260, 369, 373 and 167 days, respectively. The younger the patient, the lower the risk of fracture and, consequently, the greater the benefit for those few who actually could benefit. Conclusions. The benefit in terms of average postponement of hip fractures from osteoporosis intervention was, other things being equal, greatest in women aged 70–90 years. Fracture postponement may represent an alternative to risk reductions in expressing the effect of osteoporosis interventions. [ABSTRACT FROM AUTHOR]

Background: Forthcoming cervical cancer screening strategies involving human papillomavirus (HPV) testing for women not vaccinated against HPV infections may increase colposcopy referral rates. We quantified health and resource trade-offs associated with alternative HPV-based algorithms to inform decision-makers when choosing between candidate algorithms.Methods: We used a mathematical simulation model of HPV-induced cervical carcinogenesis in Norway. We compared the current cytology-based strategy to alternative strategies that varied by the switching age to primary HPV testing (ages 25-34 years), the routine screening frequency (every 3-10 years), and management of HPV-positive, cytology-negative women. Model outcomes included reductions in lifetime cervical cancer risk, relative colposcopy rates, and colposcopy rates per cervical cancer prevented.Results: The age of switching to primary HPV testing and the screening frequency had the largest impacts on cancer risk reductions, which ranged from 90.9% to 96.3% compared to no screening. In contrast, increasing the follow-up intensity of HPV-positive, cytology-negative women provided only minor improvements in cancer benefits, but generally required considerably higher rates of colposcopy referrals compared to current levels, resulting in less efficient cervical cancer prevention.Conclusions: We found that in order to maximise cancer benefits HPV-based screening among unvaccinated women should not be delayed: rather, policy makers should utilise the triage mechanism to control colposcopy referrals. [ABSTRACT FROM AUTHOR]

Objective: We sought to identify predictors of preferences for cesarean among pregnant women, and estimate how different predictors influence preferences. Study Design: This was a cross-sectional study based on the Norwegian Mother and Child Cohort Study (n = 58,881). Results: Of the study population, 6% preferred cesarean over vaginal delivery. While 2.4% of nulliparous had a strong preference for cesarean, the proportion among multiparous was 5.1%. The probability that a woman, absent potential predictors, would have a cesarean preference was similar (<2%) for both nulliparous or multiparous. In the presence of concurrent predictors such as previous cesarean, negative delivery experience, and fear of birth, the predicted probability of a cesarean request ranged from 20–75%. Conclusion: The proportion of women with a strong preference for cesarean was higher among multiparous than nulliparous women, but the difference was attributable to factors such as previous cesarean or fear of delivery and not to parity per se. [ABSTRACT FROM AUTHOR]

The article focuses on a survey which examined the views of the society on the treatment of rare diseases in older people in Norway. Survey respondents are Norwegians who are aged 40 to 67, who were asked to chose between funding rare disease treatment or funding treatment for a common disease. It discovered that there is no societal preference for rare diseases.

Objective: The aim of this study was to test the hypothesis that obstetricians'' choice of delivery method is influenced by their risk attitude and perceived risk of complaints and malpractice litigation. Study Design: The choice of delivery method in ambiguous cases was studied in a nationwide survey of Norwegian obstetricians (n = 716; response rate, 71%) using clinical scenarios. The risk attitude was measured by 6 items from the Jackson Personality Inventory-Revised. Results: The proportion of obstetricians consenting to the cesarean request varied both within and across the scenarios. The perceived risk of complaints and malpractice litigation was a clear determinant of obstetricians'' choice of cesarean in all of the clinical scenarios, whereas no impact was observed for risk attitude. Conclusion: Obstetricians'' judgments about cesarean request in ambiguous clinical cases vary considerably. Perceived risk of complaints and litigation is associated with compliance with the requested cesarean. [Copyright &y& Elsevier]

The article examines ways to describe the benefits of risk-reducing treatments. It aims to determine a laypersons responses to scenarios that describe benefits as postponing an adverse event or the equivalent the number needed to treat (NNT) with the use of cross-sectional survey with random allocation to different scenarios.

Presents a correction to the article "Does the Early Adopter of Drugs Exist? A Population-Based Study of General Practitioners' Prescribing of New Drugs" that was previously published online in the February 4, 2005 issue of the "European Journal of Clinical Pharmacology."

Presents comments on the reply by Reventlow et al. for their article related to concept of risk communication in relation to a patient with osteoporosis as published in December 2002 issue of 'Scandinavian Journal of Primary Health Care.' Disagreement over conclusions drawn by Reventlow et al. from their observations; Assertion over personal valuation of risk deductions; Importance of risk in medical practice.

Background: National EQ-5D value sets are developed because preferences for health may vary in different populations. UK values are lower than US values for most of the 243 possible EQ-5D health states. Although similar protocols were used for data collection, analytic choices regarding how to model values from the collected data may also influence national value sets. Participants in the UK and US studies assessed the same subset of 42 EQ-5D health states using the time trade-off (TTO) method. However, different methods were used to transform negative values to a range bounded by 0 and -1, and values for all 243 health states were estimated using two different regression models. The transformation of negative values is inconsistent with expected utility theory, and the choice of which transformation method to use lacks a theoretical foundation. Objectives: Our objectives were to assess how much of the observed difference between the UK and US EQ-5D value sets may be explained by the choice of transformation method for negative values relative to the choice of regression model and the differences between elicited TTO values in the respective national studies (datasets). Methods: We applied both transformation methods and both regression models to each of the two datasets, resulting in eight comparable value sets We arranged these value sets in pairs in which one source of difference (transformation method, regression model or dataset) was varied. For each of these paired value sets, we calculated the mean difference between the two matching values for each of the 243 health states. Finally, we calculated the mean utility gain for all possible transitions between pairs of EQ-5D health states within each value set and used the difference in transition scores as a measure of impact from changing transformation method, regression model or dataset. Results: The mean absolute difference in values was 1.5 times larger when changing the transformation method than when using different datasets. The choice of transformation method had a 3.2 times larger effect on the mean health gain (transition score) than the choice of dataset. The mean health gain in the UK value set was 0.09 higher than in the US value set. Using the UK transformation method on the US dataset reduced this absolute difference to 0.02. The choice of regression model had little overall impact on the differences between the value sets. Conclusions: Most of the observed differences between the UK and US value sets were caused by the use of different transformation methods for negative values, rather than differences between the two study populations as reflected in the datasets. Changing the regression model had little impact on the differences between the value sets. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: In EuroQol five-dimensional questionnaire valuation studies, each participant typically assesses more than 10 hypothetical health states by using the time trade-off (TTO) method. We wanted to explore potential learning effects when using the TTO method, that is, whether the valuations were affected by the number of previously rated health states (the sequence number). Methods: We included 3773 respondents from the US EQ-5D valuation study, each of whom valued 12 health states (plus unconscious) in random order. With linear regression, we used sequence number to predict mean and standard deviations across all health states. We repeated the analysis separately for TTO responses indicating a state better than death and a state worse than death. Each TTO value requires a specific number of choice iterations. To test whether respondents used fewer iterations with experience, we used linear regression with sequence number as the independent variable and number of iterations as the dependent variable. Results: Mean TTO values were fairly stable across the sequence number, but analyzing state better than death and state worse than death values separately revealed a tendency toward more extreme values: state better than death values increased by 0.02, while state worse than death values decreased by 0.21 (P < 0.0001) over the full sequence. The standard deviations increased slightly, while the number of choice iterations was the same over the sequence number. The findings were stable across the levels of health state severity, age, and sex. Conclusions: TTO values become more extreme with increasing experience. Because of the randomized valuation order, these effects do not bias specific health states; however, they reduce the overall validity and reliability of TTO values. [Copyright &y& Elsevier]

The increasing use of the risk concept in healthcare has caused concern among medical doctors, especially general practitioners (GPs). Critics have claimed that risk identification and intervention create unfounded anxiety, that the concept of risk is not useful at the individual patient level, that patients' risk concept is different from an epidemiological one, that resources are better spent elsewhere, or that commercial interests take advantage of risk information to promote sales. In this paper the authors discuss the concept of risk and address the critique. There is evidence that commercial interests promote risk interventions, that patients may misunderstand risk information, and that risk information can cause unnecessary anxiety. The authors have found no empirical data on the amount of time primary healthcare providers spend on risk interventions, and have not identified any valid arguments that risk information is not useful for the individual patient. Decision-making under uncertainty is a core element of medical practice, and GPs need to be suitably trained to inform patients such that they make good decisions when they are faced with uncertainty. The concept of risk is therefore useful for GPs, and in fact a key issue. It is concluded that risk critique should be based on sound theory and empirical data. Critics may do well in making clear distinctions between facts and value judgements. [ABSTRACT FROM AUTHOR]

Background: There is ample evidence for several pharmaceutical treatments that adherence in terms of treatment duration and dose is suboptimal. The actual drug intake cannot be observed directly in prescription databases, which only register drug redeemed and a limited number of patient characteristics. Consequently, the actual dose and duration of treatment must be inferred from observed redemptions. Persistence can then be expressed as treatment duration (also referred to as drug survival). Method: We used data from the Norwegian Prescription Database (NorPD) on redemptions of statins (ATCcode C10AA) for the period 2010-2019 to explore three methods for determining prescription durations and in turn persistence (treatment duration): (i) The DDD-method using the number of DDD redeemed; (ii) The dose-unit approach using the number of tablets redeemed; (iii) The reverse waiting time distribution method (WTD), which estimates prescription duration as the 90th percentile of the distribution within which patients in ongoing treatment will have a new subsequent redemption. The three methods for estimating prescription duration were then used to estimate treatment duration using Kaplan Meier (KM) survival functions. For the DDD-method and the dose-unit approach we conducted sensitivity analyses assuming that one DDD or one tablet would last for 1.00, 1.25 or 2.00 days. We also tested the impact of grace periods in sensitivity analyses. Results: Treatment duration and drug survival varied substantially for the same patients depending on the chosen method, duration of a DDD or a tablet, and inclusion of grace periods. The 25th percentile of treatment duration was 100 days for the DDD approach with one DDD per day, 100 days with the dose-unit approach with one tablet per day and 453 days with the WTD approach. Conclusion: When estimating treatment duration from prescription databases one should be aware that these measures of persistence are highly influenced by the chosen methodology. The choice of method should be informed by the clinical context with a preference for use of methods based on a formal model. [ABSTRACT FROM AUTHOR]

Background: When comparing mammography-screening participants and non-participants, estimates of reduction in breast-cancer mortality may be biased by poor baseline comparability. We used negative controls to detect uncontrolled confounding.Methods: We designed a closed cohort of Danish women invited to a mammography-screening programme at age 50-52 years in Copenhagen or Funen from 1991 through 2001. We included women with a normal screening result in their first-invitation round. Based on their second-invitation round, women were divided into participants and non-participants and followed until death, emigration or 31 December 2014, whichever came first. We estimated hazard ratios (HRs) of death from breast cancer, causes other than breast cancer and external causes. We added dental-care participation as an exposure to test for an independent association with breast-cancer mortality. We adjusted for civil status, parity, age at first birth, educational attainment, income and hormone use.Results: Screening participants had a lower hazard of breast-cancer death [HR 0.47, 95% confidence interval (CI) 0.32, 0.69] compared with non-participants. Participants also had a lower hazard of death from other causes (HR 0.43, 95% CI 0.39, 0.46) and external causes (HR 0.35, 95% CI 0.23, 0.54). Reductions persisted after covariate adjustment. Dental-care participants had a lower hazard of breast-cancer death (HR 0.75, 95% CI 0.56, 1.01), irrespective of screening participation.Conclusions: Negative-control associations indicated residual uncontrolled confounding when comparing breast-cancer mortality among screening participants and non-participants. [ABSTRACT FROM AUTHOR]

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have proved to reduce low density lipoprotein cholesterol levels in numerous clinical trials. In two large clinical trials, PCSK9 inhibitor treatment reduced the risk of cardiovascular disease. Our aim was to explore the impact of varying assumptions about clinical effectiveness on health and economic outcomes for patients with familial hypercholesterolemia. We used a previously published and validated Norwegian model for cardiovascular disease. The model was updated with recent data from the world's second largest registry of patients with genetically confirmed familial hypercholesterolemia. We performed analyses for 24 different subgroups of patients based on age, gender, statin tolerance and previous history of cardiovascular disease. In 1 out of 24 subgroups, PCSK9 inhibitors were cost-effective when effectiveness was modelled using direct relative efficacy as reported in the FOURIER trial. When using assumptions, as suggested in a recent consensus statement from the European Atherosclerosis Society, 14 subgroups were cost-effective. Cost-effectiveness of PCSK9 inhibitors depends highly on assumptions regarding effectiveness. Basing assumptions only on randomised controlled trials, and not taking into account varying effects based on baseline cholesterol level, results in much fewer groups being cost-effective. Image 1 • New drugs for treating high cholesterol are effective but expensive. • Concerns have been raised regarding the cost-effectiveness of these drugs. • There exist disagreements regarding the effectiveness of the drugs. • PCSK9 inhibitors are cost-effective in only one subgroup of patients when assuming similar effect regardless of LDL-C level. • PCSK9 inhibitors are cost-effective in most subgroups when assuming increased effect for patients with higher LDL-C level. [ABSTRACT FROM AUTHOR]

Background: Patients with methicillin-resistant S. aureus (MRSA) are thought to incur additional costs for hospitals due to longer stay and contact isolation. The aim of this study was to assess the costs associated with MRSA in Norwegian hospitals. Methods: Analyses were based on data fromSouth-Eastern Norway for the year 2012 as registered in the Norwegian Surveillance System for Communicable Diseases and the Norwegian Patient Registry. We used a matched case-control method to compare MRSA diagnosed inpatients with non-MRSA inpatients in terms of length of stay, readmissions within 30 days from discharge, as well as the Diagnosis-Related Group (DRG) based costs. Results: Norwegian patients with MRSA stayed on average 8 days longer in hospital than controls, corresponding to a ratio of mean duration of 2.08 (CI 95%, 1.75-2.47) times longer.A total of 14% of MRSA positive inpatients were readmitted compared to 10% among controls. However, the risk of readmission was not significantly higher for patients with MRSA. DRG based hospital costs were 0.37 (95% CI, 0.19-0.54) times higher among cases than controls, with a mean cost of EUR13,233(SD 26,899) and EUR7198(SD 18,159) respectively. Conclusion: The results of this study indicate that Norwegian patients with MRSA have longer hospital stays, and higher costs than those without MRSA. [ABSTRACT FROM AUTHOR]

Purpose: The de facto standard method for valuing EQ-5D health states is the time trade-off (TTO), an iterative choice procedure. The TTO requires a starting point (SP), an initial offer of time in full health which is compared to a fixed offer of time in impaired health. From the SP, the time in full health is manipulated until preferential indifference. The SP is arbitrary, but may influence respondents, an effect known as anchoring bias. The aim of the study was to explore the potential anchoring effect and its magnitude in TTO experiments.Methods: A total of 1249 respondents valued 8 EQ-5D health states in a Web study. We used the lead time TTO (LT-TTO) which allows eliciting negative and positive values with a uniform method. Respondents were randomized to 11 different SPs. Anchoring bias was assessed using OLS regression with SP as the independent variable. In a secondary experiment, we compared two different SPs in the UK EQ-5D valuation study TTO protocol.Results: A 1-year increase in the SP, corresponding to an increase in TTO value of 0.1, resulted in 0.02 higher recorded LT-TTO value. SP had little impact on the relative distance and ordering of the eight health states. Results were similar to the secondary experiment.Conclusion: The anchoring effect may bias TTO values. In this Web-based valuation study, the observed anchoring effect was substantial. Further studies are needed to determine whether the effect is present in face-to-face experiments. [ABSTRACT FROM AUTHOR]

Background: Decision makers often need to simultaneously consider multiple criteria or outcomes when deciding whether to adopt new health interventions.Objectives: Using decision analysis within the context of cervical cancer screening in Norway, we aimed to aid decision makers in identifying a subset of relevant strategies that are simultaneously efficient, feasible, and optimal.Methods: We developed an age-stratified probabilistic decision tree model following a cohort of women attending primary screening through one screening round. We enumerated detected precancers (i.e., cervical intraepithelial neoplasia of grade 2 or more severe (CIN2+)), colposcopies performed, and monetary costs associated with 10 alternative triage algorithms for women with abnormal cytology results. As efficiency metrics, we calculated incremental cost-effectiveness, and harm-benefit, ratios, defined as the additional costs, or the additional number of colposcopies, per additional CIN2+ detected. We estimated capacity requirements and uncertainty surrounding which strategy is optimal according to the decision rule, involving willingness to pay (monetary or resources consumed per added benefit).Results: For ages 25 to 33 years, we eliminated four strategies that did not fall on either efficiency frontier, while one strategy was efficient with respect to both efficiency metrics. Compared with current practice in Norway, two strategies detected more precancers at lower monetary costs, but some required more colposcopies. Similar results were found for women aged 34 to 69 years.Conclusions: Improving the effectiveness and efficiency of cervical cancer screening may necessitate additional resources. Although efficient and feasible, both society and individuals must specify their willingness to accept the additional resources and perceived harms required to increase effectiveness before a strategy can be considered optimal. [ABSTRACT FROM AUTHOR]

Abstract: The standard practice in cost-effectiveness analyses of health care is to assign a linear value to increasing lifetime gains. The aim of the current study was to examine the possible existence of non-linear utility for short life extensions. A representative sample of the Norwegian population, aged 40–59 years (n =2402), was asked to imagine that they had a limited remaining lifetime (1 year or 10 years) and were offered a treatment that would increase lifetime by a specified amount of time from 1 week to 1 year. In all scenarios, the price per week of life extension was held constant. The proportion of respondents that accepted the treatment increased with increasing extensions, indicating a convex utility function. The result suggests increasing marginal utility for life extensions up to 1 year. [ABSTRACT FROM AUTHOR]

Abstract: Background: Streptococcus pneumoniae is a frequent bacterial cause of serious infections that may cause permanent sequelae and death. A 7-valent conjugate vaccine may reduce the incidence of pneumococcal disease, but some previous studies have questioned the cost-effectiveness of the vaccine. The aim of this study was to estimate costs and health consequences of adding this pneumococcal vaccine to the Norwegian childhood vaccination programme, taking the possibility of herd immunity into account. Methods: We developed a simulation model (Markov-model) using data on the risk of pneumococcal disease in Norway, the efficacy of the vaccine as observed in clinical trials from other countries and adjusted for serotype differences, the cost of the vaccine and quality of life for patients with sequelae from pneumococcal disease. The results were expressed as incremental (additional) costs (in euros; €1.00≈NOK8.37), incremental life years and incremental quality adjusted life years. Four different sets of main results are presented: costs and (quality adjusted) life years, with and without indirect costs (the value of lost production due to work absenteeism) and with and without potential herd immunity (i.e. childhood vaccination protects adults against pneumococcal disease). Results: When indirect costs were disregarded, and four vaccine doses used, the incremental cost per life year gained was €153,000 when herd immunity was included, and €311,000 when it was not. When accounting for indirect costs as well, the cost per life year gained was €58,000 and €124,000, respectively. Assuming that three vaccine doses provide the same protection as four, the cost per life year gained with this regimen was €90,000 with herd immunity and €184,000 without (when indirect costs are disregarded). If indirect costs are also included, vaccination both saves costs and gains life years. Interpretation/conclusion: In Norway, governmental guidelines indicate that only interventions with cost per life year of less than €54,000 should be implemented. This implies that four dose vaccination is not cost-effective even if decision makers includes both herd immunity and indirect costs in their decisions. If three doses offer the same protection as four doses, however, vaccination would be cost-saving when indirect costs are included, but not with only herd immunity. Comment: In the autumn of 2005, the Norwegian Government decided to include PCV-7 in the vaccination program. This analysis was used by the Ministry of Health and Ministry of Finance during the decision process. [Copyright &y& Elsevier]

Pharmacological interventions for osteoporosis may reduce morbidity and mortality, but they incur additional health care costs. The aim was to quantify the additional costs and health benefits of prescribing alendronate 10 mg and calcium/vitamin D daily for 71-year-old women with a fracture risk twice that of the population average in stead of calcium/vitamin D alone. A state transition model based primarily on Scandinavian data was developed. Women were followed from age of 71 years until 100. Alendronate was assumed to reduce the fracture risk by 50%. Health benefits from the interventions were expressed in terms of life years, quality adjusted life years, and fractures avoided. Societal costs were estimated using literature estimates and Danish tariffs. All costs were measured in 2002 Danish Kroner (DKK). Future costs and benefits were discounted at 5% per year. The incremental cost per QALY gained was DKK125,000 while the cost per life year gained was DKK 374,000. The use of alendronate was cost-saving when 1) the treatment was extended to five years, 2) the risk of fracture was four times the population average, 3) the effect of alendronate was assumed to persist for three years after discontinuation of treatment, 4) a greater proportion had severe sequelae after a hip fracture, or 5) the start of therapy was delayed until age of 77 years. In conclusion, the use of alendronate compares well with other well established therapies in terms of cost-effectiveness in older women with high risk of fracture. [ABSTRACT FROM AUTHOR]

Background: Information on the benefits of therapeutic interventions can ve expressed in various ways, including relative risk reduction, absolute risk reduction, and number needed to treat (NNT). An alternative to such risk-based measures is postponement of an adverse outcome (eg, hip fracture in the case of osteoporosis).Objective: The goal of this study was to examine whether laypersons'' perception of the benefit of an osteoporosis therapy differs when it is presented in terms of the NNT to avoid 1 hip fracture compared with the duration of postponement of hip fracture.Methods: This was a cross-sectional, randomized, controlled trial. Face-to-face interviews of a representative sample of the Danish population were conducted in respondents'' homes. Respondents were randomized to receive information about the benefits of a hypothetical osteoporosis intervention either in terms of different magnitudes of NNT (10, 50, 100, or 400) or different durations of postponement of hip fracture (1 month, 6 months, 1 year, or 4 years). Participants were subsequently asked if they would consent to the intervention.Results: A total of 1728 individuals were contacted at home and asked if they would take part in a face-to-face interview; 967 (56%) were successfully interviewed. The age (mean age, 44.5 years; range, 20–74 years) and sex distrivution (51% male, 50% female) of the sample was similar to that of the general Danish population. Based on NNTs of 10, 50, 100, and 400, the proportions of responsiveness [Copyright &y& Elsevier]