• Axel Svedbom, Fredrik Borgström, Emma Hernlund, Oskar Ström, Vidmantas Alekna, Maria Luisa Bianchi, Patricia Clark, Manuel Díaz Curiel, Hans Peter Dimai, Mikk Jürisson, Anneli Uusküla, Margus Lember, Riina Kallikorm, Olga Lesnyak, Eugene McCloskey, Olga Ershova, Kerrie M Sanders, Stuart Silverman, Marija Tamulaitiene, Thierry Thomas, TostesonAnna N AANAThe Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, USA., Bengt Jönsson, and John A Kanis.
• Mapi, Stockholm, Sweden. axel.svedbom@mapigroup.se.
• Qual Life Res. 2018 Mar 1; 27 (3): 707-716.

IntroductionThe International Costs and Utilities Related to Osteoporotic fractures Study is a multinational observational study set up to describe the costs and quality of life (QoL) consequences of fragility fracture. This paper aims to estimate and compare QoL after hip, vertebral, and distal forearm fracture using time-trade-off (TTO), the EuroQol (EQ) Visual Analogue Scale (EQ-VAS), and the EQ-5D-3L valued using the hypothetical UK value set.MethodsData were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months after fracture. Health state utility values (HSUVs) were derived for each fracture type and time-point using the three approaches (TTO, EQ-VAS, EQ-5D-3L). HSUV were used to estimate accumulated QoL loss and QoL multipliers.ResultsIn total, 1410 patients (505 with hip, 316 with vertebral, and 589 with distal forearm fracture) were eligible for analysis. Across all time-points for the three fracture types, TTO provided the highest HSUVs, whereas EQ-5D-3L consistently provided the lowest HSUVs directly after fracture. Except for 13-18 months after distal forearm fracture, EQ-5D-3L generated lower QoL multipliers than the other two methods, whereas no equally clear pattern was observed between EQ-VAS and TTO. On average, the most marked differences between the three approaches were observed immediately after the fracture.ConclusionsThe approach to derive QoL markedly influences the estimated QoL impact of fracture. Therefore the choice of approach may be important for the outcome and interpretation of cost-effectiveness analysis of fracture prevention.

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