CEA/CUA Neutral benefit CEA/CUA* Net harms None^ Non-inferior CEA/CUA CEA/CUA* None^ Inferior Net clinical benefit CEA/CUA None^ None^ Neutral benefit CEA/CUA* Net harms None^ Abbreviations: CEA = cost-effectiveness analysis; CUA = cost-utility analysis * May be reduced to cost-minimisation analysis. Cost-minimisation analysis should only be presented when the proposed service has been indisputably demonstrated to be no worse than its main comparator(s) in terms of both effectiveness and safety, so the difference between the service and the appropriate comparator can be reduced to a comparison of costs. In most cases, there will be some uncertainty around such a conclusion (i.e., the conclusion is often not indisputable). Therefore, when an assessment concludes that an intervention was no worse than a comparator, an assessment of the uncertainty around this conclusion should be provided by presentation of cost-effectiveness and/or cost-utility analyses. ^ No economic evaluation needs to be presented; MSAC is unlikely to recommend government subsidy of this intervention Questions for the review relating to the economic evaluation Cost effectiveness models should be undertaken: To establish the baseline scenario: What are the downstream costs and outcomes without the proposed intervention? To assess the proposed scenario: What are the downstream costs and outcomes with the proposed intervention? As throughout the DAP, sensitivity analyses should be undertaken around: The factors, ages and eligibility criteria as specified in the proposal; The variables as advised by the available evidence; The variables as advised by PASC as being informative for sensitivity analyses to inform the final decision making. Specifically, what impact does treatment with aromatase inhibitors have on bone mineral density as a surrogate for minimal trauma fracture? This should include a consideration of the effect of other possible prognostic factors including age and previous treatment with tamoxifen. The economic analysis should account for different thresholds for therapy as advised by the available evidence. The economic evaluation should account for all patients in the target population who become eligible for current MBS items (for example through age, minimal trauma fracture, skeletal metastases or premature menopause).
PASC acknowledges that DXA is associated with low radiation but that increasing the availability of DXA may significantly increase the exposure of the proposed population to ionising radiation, especially when this population includes young women. This issue should be addressed in the assessment of evidence. Health care resources In terms of healthcare resource information, all issues and data inputs will be examined and reported in full in the assessment report. 7 List of resources to be considered in the economic analysis Provider of resource Setting in which resource is provided Proportion of patients receiving resource Number of of resource per relevant time horizon per patient receiving resource Disaggregated unit cost MBS Safety net Other govt budget Private health insurer Patient Total cost Resources provided to identify eligible population of age and risk factor status public TBA Resources provided to deliver comparator 1 GP visit to assess risk and discuss lifestyle public Resources provided in association with comparator 1 (e.g., pre-treatments, co-administered interventions, resources used to monitor or in follow-up, resources used in management of adverse events, resources used for treatment of down-stream conditions) Dietary Patient cost associated with a fracture Public or private hospital Costs associated with recovery from a fracture Patient cost Resource 2, etc Resources provided to deliver proposed intervention Dual-Energy X-ray Technician Mainly private, but there TBA 1 per patient MBS
Fracture must have been demonstrated radiologically and the year of plain x-ray, CT or MRI scan must be documented in the patient’s medical records when treatment is initiated. A vertebral fracture is defined as a ≥20% reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body or a ≥ 20% reduction in any of these heights compared to the vertebral body above or below the affected vertebral body 35 mg + 1.25g (enteric coated) N/A For preservation of bone mineral density in patients on long-term glucocorticoid therapy patients are undergoing continuous treatment with a dose equal to or greater than 7.5 mg of prednisone or equivalent per day. Prescribers need to demonstrate that the patient has been on continuous therapy for 3 months or more and demonstrate that the patient is osteopenic. <-1.0 4122 Corticosteroid-induced osteoporosis in a patient currently on long-term (≥ 3 months), high-dose (7.5 mg/day prednisolone or equivalent) corticosteroid therapy. ≤-1.5 4117 Osteoporosis in a patient aged 70 or older. Patient must not receive concomitant treatment with any other PBS-subscribed anti-resorptive agent for this condition. Date, site (femoral neck or lumbar spine) and score of the qualifying BMD measurement must be documented in the patient’s medical records when treatment is initiated. ≤-3.0 4123 Established osteoporosis in a patient with fracture due to minimal trauma. Patient must not receive concomitant treatment with any other PBS-subscribed anti-resorptive agent for this condition. N/A