Osteoporosis International

, Volume 30, Issue 9, pp 1745–1754 | Cite as

Cost-effectiveness of pharmacological fracture prevention for osteoporosis as prescribed in clinical practice in France, Germany, Italy, Spain, and the United Kingdom

  • A. Svedbom
  • P. Hadji
  • E. Hernlund
  • R. Thoren
  • E. McCloskey
  • R. Stad
  • B. StollenwerkEmail author
Original Article



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.


Costs 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.

Authors’ contributions

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

Financial disclosure

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



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.ICONStockholmSweden
  2. 2.Frankfurt Center of Bone DiseaseFrankfurt/MainGermany
  3. 3.Philips-University of MarburgMarburgGermany
  4. 4.Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
  5. 5.Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone ResearchUniversity of SheffieldSheffieldUK
  6. 6.Amgen Europe (GmbH)RotkreuzSwitzerland

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