Using economics to prioritize research: a case study of randomized trials for the prevention of hip fractures due to osteoporosis

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. 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. 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. Relatively simple economic modelling exercises can inform research priorities and could help optimize the use of scarce research resources.