Position Paper

Osteoporosis International

, Volume 18, Issue 1, pp 9-23

First online:

Cost-effectiveness of the treatment and prevention of osteoporosis—a review of the literature and a reference model

  • N. ZethraeusAffiliated withCentre for Health Economics, Stockholm School of Economics
  • , F. BorgströmAffiliated withStockholm Health EconomicsMedical Management Centre at the Karolinska Institute (KI)
  • , O. StrömAffiliated withStockholm Health Economics
  • , J. A. KanisAffiliated withCentre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, UK Email author 
  • , B. JönssonAffiliated withCentre for Health Economics, Stockholm School of Economics

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The purpose of the paper is to update and review the latest developments related to modelling and economic evaluation of osteoporosis in the period 2002–2005 and further to present a reference model for the assessment of the cost-effectiveness of the prevention and treatment of osteoporosis.


The reference model is intended to be used for fracture specific interventions affecting the risk of fracture. An interface version and an extensive description of the model is available on the internet (http://​www.​healtheconomics.​se) and also accessible via the International Osteoporosis Foundation (http://​www.​osteofound.​org). The purpose of the reference model is to improve the quality and comparability of cost-effectiveness analysis in the osteoporosis field and to serve as a tool for validation of present and future cost-effectiveness models. The reference model allows the cost-effectiveness analysis to be carried out from a societal perspective including intervention, morbidity and mortality costs. The model has been extensively tested and calibrated, and meets the properties of good decision analytic modelling. The model is a state transition Markov cohort model, which is characterised by a 50-year time horizon divided into one year cycle lengths. The following health states are included: “healthy”, “hip fracture”, “spine fracture”, “wrist fracture”, “other fracture”, and “dead”.


The model is flexible and allows for the estimation of the cost-effectiveness over different ranges for a selected number of variables (e.g., age, fracture risk, cost of intervention).


Cost-effectiveness Osteoporosis Prevention