Using Economics to Prioritize Research: A Case Study of Randomized Trials for the Prevention of Hip Fractures Due to Osteoporosis

Abstract

Objectives: To assess the role of economics, in combination with clinical judgement, for setting research priorities, using osteoporosis prevention (and, as a result, hip fracture prevention) as an example. Methods: Modelling the cost and effectiveness of each of six potential interventions to prevent hip fractures over the 5-year length of a randomized trial (vitamin D injection; thiazide diuretics; hormone replacement therapy; oral calcium and vitamin D; calcium alone; calcitonin). Drug costs were derived from the Monthly Index of Medical Specialties (MIMS); averted fracture costs and estimates of effectiveness were derived from published sources. Results: Vitamin D injection proved to be the most potentially cost-effective treatment with a cost-effectiveness ratio of £584. If averted costs are included, this leads to a saving of £9 176 496 per 100 000 women treated. By contrast, the most expensive therapy was calcitonin (marginal cost-effectiveness ratio of £433 548). This suggests that priority should be given to trials assessing the effectiveness of vitamin D injections. Conclusions: Relatively simple economic modelling exercises can inform research priorities and could help optimize the use of scarce research resources.