You are interested in comparing the costs and outcomes over a 1-year time period of preventative strategies for postmenopausal women with osteoporosis. You plan to compare three options: (1) Oral Cal-More, 10 mg/day; (2) Nasal Cal-More, 200 IU/day; and (3); Long-acting Cal-More, 70 mg, once a week. (Note: These are not real product names.) The main outcome measured is the incidence of bone fracture and the effect on QALYs. Each year, about 5% of the patients taking once-a-day oral Cal-More have a fracture (95% do not), about 10% of those taking nasal Cal-More experience a fracture (90% do not), and 5% of those taking long-acting Cal-More experience a fracture (95% do not). The cost of treating a fracture is $3,000, and a fracture decreases a person’s QALY by 0.5 QALYs. Once-a-day oral Cal-More causes gastrointestinal (GI) complications in 5% of the patients. Nasal Cal-More causes nasal irritation or bleeding in 10% of the cases. Once-a-week oral Cal-More causes GI complications in 2% of the patients. The average cost of treating GI complications is $200, and QALYs are decreased by 0.2. The average cost of treating nasal problems is $100, and QALYs are decreased by 0.1.
The costs per year of the three medications are:
Once-a-day oral Cal-More = $600
Once-a-day nasal Cal-More = $800
Once-a-week oral Cal-More = $1,000
1. Calculate the average QALY for each treatment.
2. Calculate the average cost per QALY for each treatment.
3. Calculate the marginal cost per QALY between options 1 (oral once a day) and 2 (nasal once a day).
4. Calculate the marginal cost per QALY between options 1 (oral once-a-day) and 3 (oral once a week).
5. If option 1 is considered the standard treatment, place a 2 in the cell that represents the comparison of option 2 (nasal once a day) with the standard (oral once a day) Then place a 3 in the box that compares option 3 (oral once a week) to the standard (oral once a day)