Cost-effectiveness of pharmacological fracture prevention for osteoporosis as prescribed in clinical practice in France, Germany, Italy, Spain, and the United Kingdom
This study estimated the cost-effectiveness of pharmacological fracture prevention as prescribed in the five largest European countries (EU5) using the IOF reference cost-effectiveness model. Pharmacological fracture prevention as prescribed in clinical practice was cost-saving (provided more QALYs at lower costs) compared to no treatment in each of the EU5.
To estimate the real-world cost-effectiveness of pharmacological fracture prevention as prescribed in the five largest European countries by population size: France, Germany, Italy, Spain, and the United Kingdom (UK) (collectively EU5).
Materials and methods
We analyzed sales data on osteoporosis drugs in each of the EU5 to derive a hypothetical intervention that corresponds to the mix of osteoporosis medication prescribed in clinical practice. The costs for this treatment mix were obtained directly from the sales data, and the efficacy of the treatment mix was estimated by weighing the treatment-specific fracture risk reductions from a published meta-analysis. Subsequently, we estimated the cost-effectiveness using costs per quality adjusted life year (QALY) of the intervention compared to no treatment in each of the EU5 using the International Osteoporosis Foundation (IOF) reference cost-effectiveness model. The model population comprised postmenopausal women, mean age 72 years with established osteoporosis (T-score ≤ − 2.5) among whom 23.6% had a prevalent vertebral fracture. The model was populated with country-specific data from the literature.
Pharmacological fracture prevention as prescribed in clinical practice was cost-saving (provided more QALYs at lower costs) compared to no treatment in each country. The findings were robust in scenario analyses.
Pharmacological fracture prevention as prescribed in clinical practice is cost-saving in each of the EU5. Because of the under-diagnosis and under-treatment of post-menopausal osteoporosis, from a health economic perspective, further cost-savings may be reached by expanding treatment to those at increased risk of fracture currently not receiving any treatment.
KeywordsCosts and costs analysis Cost-benefit analysis Cost-effectiveness Osteoporosis Osteoporotic fracture Preventive medicine Practice patterns
The authors would like to thank Josefine Redig for quality control and formatting of the manuscript.
Björn Stollenwerk and Emma Hernlund designed the study with input from Axel Svedbom, Peyman Hadji, Eugene McCloskey, and Robert Stad. Björn Stollenwerk, Emma Hernlund, and Axel Svedbom developed the cost-effectiveness model, obtained the input data, and executed the analyses with support from Robyn Thoren. Björn Stollenwerk and Axel Svedbom led the interpretation of findings with input from the other authors. Axel Svedbom drafted the manuscript. All authors reviewed and revised this manuscript and approved the decision to submit for publication.
This study was supported by Amgen Europe GmbH.
Compliance with ethical standards
B Stollenwerk and R Stad are Amgen employees and holders of Amgen stocks/options. A Svedbom, E Hernlund, R Thoren were paid consultants to Amgen Europe GmbH through their employment at ICON Clinical Research. ICON Clinical Research has received funding from several pharmaceutical companies involved in the marketing of products for treatment of osteoporosis. P Hadji received research funding and consultancy and lecture fees from the following companies: Amgen, Elli Lilly, Novartis, Gedeon Richter, Pfizer, UCB. E McCloskey has received consultancy and/or speaker’s honoraria and/or research support from ActiveSignal, Amgen, Arthritis Research UK, AstraZeneca, Consilient Healthcare, GSK, Hologic, I3 Innovus, Internis, IOF, Lilly, Medtronic, Merck, MRC, Norvartis, Pfizer, Roch, Sanofi-Aventis, Servier, Synexus, Tethys, UCB, Unilever, and Warner Chilcott.
Conflict of interest
- 2.Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the international Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136. https://doi.org/10.1007/s11657-013-0136-1 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Harvey NC, McCloskey EV, Mitchell PJ, Dawson-Hughes B, Pierroz DD, Reginster J-Y, Rizzoli R, Cooper C, Kanis JA (2017) Mind the (treatment) gap: a global perspective on current and future strategies for prevention of fragility fractures. Osteoporos Int 28(5):1507–1529CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Van der Velde R, Wyers C, Teesselink E, Geusens P, van den Bergh JP, de Vries F, Cooper C, Harvey N, van Staa T (2017) Trends in oral anti-osteoporosis drug prescription in the United Kingdom between 1990 and 2012: variation by age, sex, geographic location and ethnicity. Bone 94:50–55CrossRefPubMedGoogle Scholar
- 20.Borgstrom F, Jonsson B, Strom O, Kanis JA (2006) An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting: based on the results of the SOTI and TROPOS trials. Osteoporos Int 17(12):1781–1793. https://doi.org/10.1007/s00198-006-0193-z CrossRefPubMedGoogle Scholar
- 22.Piscitelli P, Tarantino U, Chitano G, Argentiero A, Neglia C, Agnello N, Saturnino L, Feola M, Celi M, Raho C (2011) Updated incidence rates of fragility fractures in Italy: extension study 2002–2008. Clinical cases in mineral and bone. metabolism 8(3):54Google Scholar
- 25.Bleibler F, Rapp K, Jaensch A, Becker C, König H-H (2014) Expected lifetime numbers and costs of fractures in postmenopausal women with and without osteoporosis in Germany: a discrete event simulation model. BMC Health Serv Res 14(1):284. https://doi.org/10.1186/1472-6963-14-284 CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Excellence NIfC (2007) Final appraisal determination. Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women. LondonGoogle Scholar
- 34.Scotti L, Arfe A, Zambon A, Merlino L, Corrao G (2014) Cost-effectiveness of enhancing adherence with oral bisphosphonates treatment in osteoporotic women: an empirical approach based on healthcare utilisation databases. BMJ Open 4(3):e003758. https://doi.org/10.1136/bmjopen-2013-003758 CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Gutierrez L, Roskell N, Castellsague J, Beard S, Rycroft C, Abeysinghe S, Shannon P, Robbins S, Gitlin M (2011) Study of the incremental cost and clinical burden of hip fractures in postmenopausal women in the United Kingdom. J Med Econ 14(1):99–107. https://doi.org/10.3111/13696998.2010.547967 CrossRefPubMedGoogle Scholar
- 36.Gutierrez L, Roskell N, Castellsague J, Beard S, Rycroft C, Abeysinghe S, Shannon P, Gitlin M, Robbins S (2012) Clinical burden and incremental cost of fractures in postmenopausal women in the United Kingdom. Bone 51(3):324–331. https://doi.org/10.1016/j.bone.2012.05.020 CrossRefPubMedGoogle Scholar
- 37.National Institute for Health and Care Excellence (2017) Bisphosphonates for treating osteoporosis TA464Google Scholar
- 38.Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, Svensson O, Abdon P, Ornstein E, Lunsjo K, Thorngren KG, Sernbo I, Rehnberg C, Jonsson B (2006) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 17(5):637–650. https://doi.org/10.1007/s00198-005-0015-8 CrossRefGoogle Scholar
- 40.Eurostat database (2017) http://ec.europa.eu/eurostat/data/database
- 41.Svedbom A, Borgstom F, Hernlund E, Strom O, Alekna V, Bianchi ML, Clark P, Curiel MD, Dimai HP, Jurisson M, Kallikorm R, Lember M, Lesnyak O, McCloskey E, Sanders KM, Silverman S, Solodovnikov A, Tamulaitiene M, Thomas T, Toroptsova N, Uuskula A, Tosteson ANA, Jonsson B, Kanis JA (2017) Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures-results from the ICUROS. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 29:557–566. https://doi.org/10.1007/s00198-017-4317-4 CrossRefGoogle Scholar
- 45.Poor G, Atkinson EJ, O'Fallon WM, Melton LJ, 3rd (1995) Determinants of reduced survival following hip fractures in men. Clin Orthop Relat Res (319):260-265Google Scholar