Original Research Article

Applied Health Economics and Health Policy

, Volume 9, Issue 4, pp 259-273

First online:

Cost effectiveness of secondary vs tertiary prevention for post-menopausal osteoporosis

  • Dirk MuellerAffiliated withHealth Economics, Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR) Email author 
  • , Afschin GandjourAffiliated withPennington Biomedical Research Center/Louisiana State University

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The aging of the population is likely to increase the number of osteoporosis-related fractures, such as hip fractures, and hence the economic burden for society. Therefore, strategies to identify women at increased risk are of major interest.


The aim of this study was to determine the cost effectiveness of preventive services for osteoporosis, comparing secondary plus tertiary prevention (SP/TP) versus tertiary prevention (TP) alone in post-menopausal women in Germany.


A cost-utility analysis and a budget-impact analysis were performed from the perspective of the German statutory health insurance (SHI). A Markov model simulated costs and benefits discounted at 3% over a lifetime horizon.


Cost effectiveness of TP compared with no screening was €669, €477 and €385 per QALY for women aged 60, 70 and 80 years, respectively (year 2010 values). In women aged 50 years, TP dominated no prevention. Cost effectiveness of SP/TP compared with TP was €4543, €19 791, €8670 and €3368 for women aged 50, 60, 70 and 80 years, respectively. SP/TP resulted in additional costs of €109 million or 0.10% of the SHI’s annual budget (TP alone = €8 million).


Compared with TP, a strategy based on SP/TP appears to be more expensive but more effective in each age group. Given that cost effectiveness seems acceptable, allocation of resources to SP/TP to decrease post-menopausal osteoporotic fracture risk may be justified.