The productivity gain by preventing first and subsequent hip fractures in osteoporotic patients as a result of optimal treatment

Abstract

Background: Preventing hip fractures could prevent patient disability and premature death, and lead to substantial societal savings in terms of productivity gains. However, the Norwegian government has decided against emphasizing productivity gains in prioritization decisions for financing pharmaceutical drugs. The question, however, remains whether including productivity gains could lead to better prioritizations. In our study we therefore aim to estimate the productivity gain by preventing first and subsequent hip fractures through optimal treatment of osteoporotic patients in Norway.

Method: A Markov cohort model was developed based on the incidence of hip fractures and deaths in Norway. All work-active 50-year old men and women in Norway were separately simulated through the model until retirement or death. A 30% RRR was applied to the model state transitions as a primary and secondary treatment intervention. Productivity gains were calculated based on averted sick leave, averted permanent disability, and averted hip fracture related death using the human capital approach (HCA) and a societal gain calculation.

Results: The total present productivity gain using the HCA was 122 million NOK. Averted permanent disability contributed with approximately 80% to the total estimate. Based on the 105 averted hip fractures due to the intervention, the average productivity gain per prevented hip fracture using the HCA was 1 167 000 NOK. The total productivity gain and the average productivity gain per prevented hip fracture was higher in men compared to women. The total societal gain and the average societal gain per prevented hip fracture was lower than the estimates obtained using the HCA in both sexes.

Conclusion: Optimal pharmacological treatment of osteoporosis in middle-aged patients had a positive impact on work productivity. The estimated total productivity gain was low relative to other findings, but the productivity gain per prevented hip fracture was substantial. In addition, the productivity gain in the entire work-active osteoporotic population in Norway can be significant if patients are treated optimally. Excluding these monetary gains from health economic evaluations of treatment interventions can lead to a reduced cost-effectiveness of interventions and the exclusion of major societal savings. The Norwegian government should acknowledge this while evaluating the drug politics and preparing a new priority message. Future inquiries could examine the productivity gain in a broader work-active population and incorporate other important fragility fracture types.