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Cost-effective but clinically inappropriate: new NICE intervention thresholds in osteoporosis (Technology Appraisal
N C Harvey1,2,3, E McCloskey4,5, J A Kanis6,7
1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
Purpose:
To comment on the latest technology appraisal of the National Institute for Clinical Excellence (NICE) in osteoporosis.
Methods:
Review of NICE Technology Appraisal (TA464) on bisphosphonate use in osteoporosis.
Results:
The NICE appraisal on bisphosphonate use in osteoporosis indicates that treatment with oral bisphosphonates may be instituted at a FRAX 10-year probability of major osteoporotic fracture above 1%. Implementation would mean that all women aged 50 years or older are deemed eligible for treatment, a position that would increase the burden of rare long-term side effects across the population.
Conclusion:
Cost-effectiveness thresholds for low-cost interventions should not be used to set intervention thresholds but rather to validate the implementation of clinically driven intervention thresholds.
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