, Volume 93, Issue 1, pp 1-14,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 21 Mar 2013

Health Technology Assessment in Osteoporosis


We review the various aspects of health technology assessment in osteoporosis, including epidemiology and burden of disease, and assessment of the cost-effectiveness of recent advances in the treatment of osteoporosis and the prevention of fracture, in the context of the allocation of health-care resources by decision makers in osteoporosis. This article was prepared on the basis of a symposium held by the Belgian Bone Club and the discussions surrounding that meeting and is based on a review and critical appraisal of the literature. Epidemiological studies confirm the immense burden of osteoporotic fractures for patients and society, with lifetime risks of any fracture of the hip, spine, and forearm of around 40 % for women and 13 % for men. The economic impact is also large; for example, Europe’s six largest countries spent €31 billion on osteoporotic fractures in 2010. Moreover, the burden is expected to increase in the future with demographic changes and increasing life expectancy. Recent advances in the management of osteoporosis include novel treatments, better fracture-risk assessment notably via fracture risk algorithms, and improved adherence to medication. Economic evaluation can inform decision makers in health care on the cost-effectiveness of the various interventions. Cost-effectiveness analyses suggest that the recent advances in the prevention and treatment of osteoporosis may constitute an efficient basis for the allocation of scarce health-care resources. In summary, health technology assessment is increasingly used in the field of osteoporosis and could be very useful to help decision makers efficiently allocate health-care resources.

This paper is based on an expert consensus meeting held by the Belgian Bone Club under the auspices of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).
J.-J. Body has received speaker and consultant fees from Amgen and Novartis, and research support from Amgen, Daïïchi-Sankyo, GlaxoSmithKline, Merck Sharp & Dohme, Novartis, Nycomed, Servier, and SMB. P. Bergmann has received speaker fees from Servier and Roche. S. Boonen has received consulting fees and/or research support from Amgen, Merck, Novartis and Servier. O. Bruyère has received grants or has been reimbursed for attending meetings from GlaxoSmithKline, IBSA, MSD, Novartis, Rottapharm, Servier, Theramex and Wyeth. J. Compston has received grant support from GlaxoSmithKline and Nycomed, advisory fees and/or speaking fees from Alliance for Better Bone Health, Amgen, Gilead, GlaxoSmithKline, Medtronic, MSD, Novartis, Nycomed, Servier, and Warner-Chilcott. C. Cooper has received consulting fees and paid advisory boards for Alliance for Better Bone Health, GlaxoSmithKline, Roche, Merck Sharp and Dohme, Lilly, Amgen, Wyeth, Novartis, Servier, and Nycomed. J.-P. Devogelaer has no conflict of interest. B. Flamion has no conflict of interest. S. Goemaere has received speakers fees and/or research support from Amgen, Daiichi-Sankyo, Eli Lilly, Glaxo SmithKline, Merck Sharp & Dohme, Novartis, Nycomed, Warner-Chillcott, Sanofi-Aventis, Servier, and Roche. M. Hiligsmann has received research grants from Amgen, Novartis, Pfizer, Servier, SMB, and consulting fees from Servier and SMB. J.-M. Kaufman has received consulting fees, paid advisory boards, lecture fees and/or grant support from Amgen, Eli Lilly, Glaxo SmithKline, Merck, Novartis, Procter & Gamble, Roche, Sanofi Aventis, Servier, and Warner-Chilcott. J.A. Kanis has received consulting fees, advisory board fees, lecture fees, and/or grant support from the majority of companies concerned with skeletal metabolism. S. Rozenberg has received speakers and/or consultant fees from Amgen, Merck Sharp & Dohme, Abbott, Will-Pharma, and Pfizer. J.-Y. Reginster on behalf of the Department of Public Health, Epidemiology and Health Economics of the University of Liège, Liège, Belgium. Consulting fees or paid advisory boards: Servier, Novartis, Negma, Lilly, Wyeth, Amgen, GlaxoSmithKline, Roche, Merckle, Nycomed, NPS, Theramex, and UCB. Lecture fees when speaking at the invitation of a commercial sponsor: Merck Sharp and Dohme, Lilly, Rottapharm, IBSA, Genevrier, Novartis, Servier, Roche, Glaxo SmithKline, Teijin, Teva, Ebewee Pharma, Zodiac, Analis, Theramex, Nycomed, and Novo-Nordisk. Grant Support from Industry: Bristol Myers Squibb, Merck Sharp & Dohme, Rottapharm, Teva, Lilly, Novartis, Roche, GlaxoSmithKline, Amgen, and Servier.