Osteoporosis International

, Volume 23, Issue 11, pp 2579–2589

Cost-effective intervention thresholds against osteoporotic fractures based on FRAX® in Switzerland

  • K. Lippuner
  • H. Johansson
  • F. Borgström
  • J. A. Kanis
  • R. Rizzoli
Original Article

DOI: 10.1007/s00198-011-1869-6

Cite this article as:
Lippuner, K., Johansson, H., Borgström, F. et al. Osteoporos Int (2012) 23: 2579. doi:10.1007/s00198-011-1869-6



FRAX-based cost-effective intervention thresholds in the Swiss setting were determined. Assuming a willingness to pay at 2× Gross Domestic Product per capita, an intervention aimed at reducing fracture risk in women and men with a 10-year probability for a major osteoporotic fracture at or above 15% is cost-effective.


The fracture risk assessment algorithm FRAX® has been recently calibrated for Switzerland. The aim of the present analysis was to determine FRAX-based fracture probabilities at which intervention becomes cost-effective.


A previously developed and validated state transition Markov cohort model was populated with Swiss epidemiological and cost input parameters. Cost-effective FRAX-based intervention thresholds (cost-effectiveness approach) and the cost-effectiveness of intervention with alendronate (original molecule) in subjects with a FRAX-based fracture risk equivalent to that of a woman with a prior fragility fracture and no other risk factor (translational approach) were calculated based on the Swiss FRAX model and assuming a willingness to pay of 2 times Gross Domestic Product per capita for one Quality-adjusted Life-Year.


In Swiss women and men aged 50 years and older, drug intervention aimed at decreasing fracture risk was cost-effective with a 10-year probability for a major osteoporotic fracture at or above 13.8% (range 10.8% to 15.0%) and 15.1% (range 9.9% to 19.9%), respectively. Age-dependent variations around these mean values were modest. Using the translational approach, treatment was cost-effective or cost-saving after the age 60 years in women and 55 in men who had previously sustained a fragility fracture. Using the latter approach leads to considerable underuse of the current potential for cost-effective interventions against fractures.


Using a FRAX-based intervention threshold of 15% for both women and men should permit cost-effective access to therapy to patients at high fracture probability based on clinical risk factors and thereby contribute to further reduce the growing burden of osteoporotic fractures in Switzerland.


AlendronateCost-effectivenessFRAX®Intervention thresholdsOsteoporosisSwitzerland10-year fracture probability

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • K. Lippuner
    • 1
    • 5
  • H. Johansson
    • 2
  • F. Borgström
    • 3
  • J. A. Kanis
    • 2
  • R. Rizzoli
    • 4
  1. 1.Osteoporosis Policlinic, InselspitalBern University Hospital and University of BernBernSwitzerland
  2. 2.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical SchoolSheffieldUK
  3. 3.LIME/MMCKarolinska InstitutetStockholmSweden
  4. 4.Division of Bone Diseases, Department of Medical SpecialtiesUniversity Hospital and Medical Faculty of GenevaGenevaSwitzerland
  5. 5.University Hospital and University of BernBernSwitzerland