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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

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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 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 $3000, 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 bleed- ing 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 = $1000 A. Draw the decision tree. B. Calculate the average cost for each treatment. C. Calculate the average QALY for each treatment. D. Calculate the average cost per QALY for each treatment. E. Calculate the marginal cost per QALY between options 1 (oral once a day) and 2 (nasal once a day). F. Calculate the marginal cost per QALY between options 1 (oral once-a-day) and 3 (oral once a week). G. If option 1 is considered the standard treatment, place a 2 in the cell that rep resents 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)

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