The broad objective of this research proposal is to improve the health of elderly men and women through osteoporosis prevention and treatment. Osteoporosis disproportionately affects the elderly and is associated with fractures that result in pain, disability, death and a large expenditure of health care resources. Attention has focused primarily on hip and vertebral fractures in women, but risks of other fractures in women and fractures in men are substantial. In 1995, men accounted for 20 percent of national expenditures for osteoporotic fracture care. Given the increasing proportion of the population that is elderly, it is imperative that sensible approaches to osteoporosis be identified and implemented. We propose to extend our previous research (AG12262) on determining cost-effective approaches for preventing hip and spine fractures in women to identify optimal strategies in men and to accommodate non-hip and non-spine fractures in men and women. There are three aims. First, the economic and quality of life impact of fractures in men and women will be evaluated. Excess costs associated with each type of fracture will be determined by analyzing longitudinal medical resource utilization and cost data among the cohort of all Olmsted County, Minnesota residents greater than or equal to 50 years of age with a fracture in 1989-91 (n=1,356) compared with a cohort of non- fracture subjects. Quality of life impacts attributable to hip and spine fractures in men and non-hip and non-spine fractures in women will be assessed through surveys of recent fracture subjects using utility measurement tools developed in our first grant. Second, the economic and quality of life impact of interventions to prevent and treat osteoporosis will be estimated by analyzing the longitudinal pattern of resource use and excess costs attributable to treated and untreated cohorts identified through the Kaiser Permanente pharmacy database. Quality of life will be assessed in a subset of subjects in these cohorts. Third, our decision-analytic cost-effectiveness models for women will be extended to include non-spine and non-hip fractures and updated with cost and utility data from aims 1 and 2. We will develop the first decision-analytic cost-effectiveness models to address osteoporosis prevention and treatment in male populations. Extensive analyses with these models will allow us to identify areas of uncertainty that impact on the cost-effectiveness of competing intervention approaches. These results will be useful in prioritizing areas for future research. With the advent of costly new therapies for osteoporosis, such data can help inform policy regarding the optimal use of these agents.
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