Original Article

Osteoporosis International

, Volume 22, Issue 3, pp 967-982

First online:

Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis

  • B. JönssonAffiliated withStockholm School of Economics Email author 
  • , O. StrömAffiliated withi3 InnovusDepartment of Learning, Informatics, Management, and Ethics, Medical Management Centre, Karolinska Institutet
  • , J. A. EismanAffiliated withUNSW, Garvan Institute of Medical Research, St Vincent’s Hospital
  • , A. PapaioannouAffiliated withMcMaster University
  • , E. S. SirisAffiliated withColumbia University
  • , A. TostesonAffiliated withDartmouth Medical School
  • , J. A. KanisAffiliated withWHO Collaborating Centre, University of Sheffield

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access



Denosumab is an injectable drug that reduces the risk of fractures. The objective was to estimate the cost-effectiveness of denosumab in a Swedish setting, also accounting for poor adherence to treatment. Denosumab is cost-effective, particularly for patients at high risk of fracture and low adherence to oral treatments.


Denosumab is a novel biologic agent developed for the treatment of osteoporosis and osteoporotic fractures that has been shown to reduce the risk of fractures in a phase III trial. The objective of this study was to estimate the cost-effectiveness of denosumab from a societal perspective compared with generic alendronate, branded risedronate, strontium ranelate, and no treatment in a Swedish setting.


A Markov cohort model was used to estimate the cost-effectiveness of denosumab given for up to 5 years to a typical Swedish patient population (women aged 71 years, T-score ≤ −2.5 SD and a prevalence of morphometric vertebral fractures of 34%). The model included treatment persistence and residual effect after discontinuation assumed to be equal to the time on treatment. Persistence with the comparator treatments and with denosumab was derived from prescription data and a persistence study, respectively.


The base-case incremental cost-effectiveness ratios were estimated at €27,000, €12,000, €5,000, and €14,000, for denosumab compared with generic alendronate, risedronate, strontium ranelate, and no treatment, respectively. Sub-optimal persistence had the greatest impact in the comparison with generic alendronate, where the difference in drug cost was large.


Improving persistence with osteoporosis treatment impacts positively on cost-effectiveness with a larger number of fractures avoided in the population targeted for treatment. Denosumab is a cost-effective alternative to oral osteoporosis treatments, particularly for patients at high risk of fracture and low expected adherence to oral treatments.


Adherence Compliance Fracture Model Persistence Sweden