Original Article

Osteoporosis International

, Volume 17, Issue 7, pp 996-1007

First online:

The cost-effectiveness of risedronate in the treatment of osteoporosis: an international perspective

  • F. BorgströmAffiliated withStockholm Health EconomicsMedical Management Centre, Karolinska Institutet Email author 
  • , Å. CarlssonAffiliated withStockholm Health Economics
  • , H. SintonenAffiliated withDepartment of Public Health, University of Helsinki
  • , S. BoonenAffiliated withLeuven University Center for Metabolic Bone Diseases and Division of Geriatric Medicine, Katholieke Universiteit Leuven
  • , P. HaentjensAffiliated withDepartment of Orthopaedics and Traumatology, Academisch Ziekenhuis van de Vrije Universiteit Brussel
  • , R. BurgeAffiliated withProcter & Gamble PharmaceuticalsDivision of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati
  • , O. JohnellAffiliated withDepartment of Orthopaedics, Malmö General Hospital
  • , B. JönssonAffiliated withDepartment of Economics, Stockholm School of Economics
  • , J. A. KanisAffiliated withStockholm Health EconomicsCentre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School

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Risedronate, a bisphosphonate for treatment and prevention of osteoporosis, has been shown in several clinical trials to reduce the risk of fractures in postmenopausal women with osteoporosis. The cost-effectiveness of risedronate treatment has previously been evaluated within different country settings using different model and analysis approaches. The objective of this study was to assess the cost-effectiveness of risedronate in postmenopausal women in four European countries—Sweden, Finland, Spain, and Belgium—by making use of the same modelling framework and analysis setup.


A previously developed Markov cohort model for the evaluation of osteoporosis treatments was used to estimate the cost-effectiveness of risedronate treatment. For each country, the model was populated with local mortality, fracture incidence, and cost data. Hip fractures, clinical vertebral fractures, and wrist fractures were included in the model.


The incremental cost per quality-adjusted life years (QALY) gained from a 5-year intervention with risedronate compared to “no intervention” in 70-year-old women at the threshold of osteoporosis [T-score = −2.5 based on National Health and Nutrition Examination Survey (NHANES) III data] and previous vertebral fracture was estimated to be €860, €19,532, €11,782, and €32,515 in Sweden, Finland, Belgium, and Spain, respectively. Among 70-year-old women at the threshold of osteoporosis without previous fracture the estimated cost per QALY gained ranged from €21,148 (Sweden) to €80,100 (Spain). The differences in cost-effectiveness between countries are mainly explained by different costs (fracture and treatment costs), fracture risks, and discount rates. Based on cost per QALY gained threshold values found in the literature, the study results indicated risedronate to be cost effective in the treatment of elderly women with established osteoporosis in all the included countries.


At a hypothetical threshold value of €40,000 per QALY gained, the results in this study indicate that risedronate is a cost-effective treatment in elderly women at the threshold of osteoporosis (i.e., a T-score of −2.5) with prevalent vertebral fractures in Sweden, Finland, Belgium, and Spain.


Belgium Cost-effectiveness Finland Fracture Osteoporosis Postmenopausal women Risedronate Spain Sweden