Osteoporosis International

, Volume 30, Issue 2, pp 299–310 | Cite as

Cost-effectiveness of implementing guidelines for the treatment of glucocorticoid-induced osteoporosis in Japan

  • K. MoriwakiEmail author
  • H. Fukuda



A model-based cost-effectiveness analysis was performed to evaluate the cost-effectiveness of implementing the clinical guideline for the treatment for glucocorticoid-induced osteoporosis (GIO). The treatment indication for GIO in the current Japanese clinical guidelines is likely to be cost-effective except for the limited patients who are at low risk for fracture.


The purpose of this study was to evaluate the cost-effectiveness of implementing the clinical guideline for the treatment for glucocorticoid-induced osteoporosis (GIO) from the perspective of the Japanese healthcare system.


A patient-level state transition model was developed to predict lifetime costs and quality-adjusted life years (QALYs) in postmenopausal Japanese women with osteopenia or osteoporosis using glucocorticoid (GC). An annual discount rate of 2% for both costs and QALYs was applied. The incremental cost-effectiveness ratio (ICER) of 5-year alendronate therapy compared with no therapy was estimated with different combinations of the risk factors such as starting age (45, 55, or 65), femoral neck BMD (% young adult mean (YAM) of 70%, 75%, or 80%), dose of GC (2.5, 5, or 10 mg per day), and the presence of previous fracture (yes or no).


For 55-year-old women using GC with a BMD of 75% of YAM, the ICER ranged from $10,958 to $ 29,727 per QALY. Scenario analyses indicated that the lower age, the lower BMD, the higher dose of GC, and the presence of previous fracture associated with lower ICER. The best-case scenario was 45-year-old women with a BMD of 70% of YAM, GC dose of 10 mg per day, and previous fracture, and resulted in healthcare cost-savings. The worst-case scenario was 65-year-old women with a BMD of 80% of YAM, GC dose of 2.5 mg per day, and no previous fracture, and resulted in the ICER of $66,791 per QALY. Sensitivity analyses in the worst-case scenario showed that the annual discount rate for costs and health benefit had the strong influence on the estimated ICER. Although the ICER was influenced by other parameters such as disutility due to vertebral fracture, efficacy of alendronate, and so on, the ICERs remained more than $50,000 per QALY.


The cost-effectiveness of preventive alendronate therapy for postmenopausal women with osteopenia or osteoporosis using GC is sensitive to age, BMD, GC dose, and the presence of previous fracture. Our analysis suggested that the treatment indication for postmenopausal women with osteopenia or osteoporosis using GC in the current Japanese clinical guidelines is likely to be cost-effective except for the limited patients who are at low risk for fracture.


Cost-effectiveness analysis Fracture prevention Glucocorticoid-induced osteoporosis Health economics 


Funding information

This work was supported by Grants-in-Aid for Scientific Research (KAKENHI) Grant Number 26870670 from the Ministry of Education, Culture, Sports, Science and Technology (MEXT)/Japan Society for the Promotion of Science (JSPS).

Compliance with ethical standards

Conflict of interest

KM has received speaker honoraria, consulting fees, or reimbursement for attending meetings from Asahi Kasei Pharma Corp., Amgen Astellas BioPharma K.K., Astellas Pharma Europe Ltd., Sumitomo Dainippon Pharma Co., Ltd., and Takeda Pharmaceutical Co., Ltd.. HF has received speaker honoraria, consulting fees, or reimbursement for attending meetings from Astellas Pharma Ltd., Nippon Becton Dickinson Company, Ltd., MSD, Eli Lilly Japan, Abbott, and KYORIN Pharmaceutical Co., Ltd.

Supplementary material

198_2018_4798_MOESM1_ESM.doc (90 kb)
ESM 1 (DOC 90 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Laboratory of Medical StatisticsKobe Pharmaceutical UniversityKobeJapan
  2. 2.Department of Health Care Administration and ManagementKyushu University Graduate School of Medical SciencesFukuokaJapan

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