An updated systematic review of Health State Utility Values for osteoporosis related conditions

  • T. Peasgood
  • K. Herrmann
  • J. A. Kanis
  • J. E. BrazierEmail author



An important component of cost effectiveness models in the field of osteoporosis is the set of Health State Utility Values (HSUVs) used for key fracture outcomes. This paper presents a review of HSUVs for key osteoporotic states (hip, wrist, shoulder, clinical, and morphometric vertebral fractures, established osteoporosis, and interaction of several fractures). It provides an update to the systematic review conducted by Brazier et al. (Osteoporos Int 13(10):768–776, 2002).

Materials and methods

A systematic search was undertaken of the main literature databases for HSUVs for established osteoporosis, vertebral, hip, wrist, and shoulder fractures were identified. Studies meeting the inclusion criteria were reviewed in terms of the patient population, the method of describing health (if not obtained directly from patients), the method of valuing health states and the source of values.


Estimates of Health State Utility Values were found across the osteoporosis conditions from 27 studies. A wide range of empirical estimates were found, partly due to differences in valuation technique (VAS, SG, TTO), descriptive system and differences in respondents (population or patient), the perspective of the task (own health or a scenario), sample size, and study quality.


The paper provides a set of multipliers representing the loss in HSUVs for use as a “reference case” in cost-effectiveness models.


Health State Utility Values Osteoporosis Quality adjusted life years Utilities 



This study review was funded by Lilly. John Brazier is funded by the UK Medical Research Council.

Supplementary material

198_2009_844_MOESM1_ESM.doc (195 kb)
198_2009_844_MOESM2_ESM.doc (642 kb)


  1. 1.
    Brazier JE, Green C, Kanis JA (2002) Committee of scientific advisors international osteoporosis foundation. A systematic review of health state utility values for osteoporosis-related conditions. Osteoporos Int 13(10):768–776PubMedCrossRefGoogle Scholar
  2. 2.
    Sculpher M, Torgerson D, Goeree R, O’Brien B (1999) A critical structured review of economic evaluations of interventions for the prevention and treatment of osteoporosis. Discussion Paper 169 York: The University of York Centre for Health Economics .Google Scholar
  3. 3.
    Brazier J, Ratcliffe J, Salomon J, Tsuchiya A (2007) Measuring and Valuing Health Benefits for Economic Valuation. Oxford University Press.Google Scholar
  4. 4.
    Kaplan RM, Sieber WJ, Ganiats TG (1997) The Quality of Well-Being scale: comparison of the interviewer administered version with a self-administered questionnaire. Psychol Health 12:783–791CrossRefGoogle Scholar
  5. 5.
    Feeny D, Furlong W, Boyle M, Torrance GW (1995) Multi-attribute health status classification systems: health utilities index. PharmacoEcon 7(8):490–502CrossRefGoogle Scholar
  6. 6.
    Dolan P (1997) Modelling valuations for EuroQol health states. Med Care 35(11):1095–1108PubMedCrossRefGoogle Scholar
  7. 7.
    Brazier JE, Roberts J, Deverill M (2002) The estimation of a preference-based measure of health from the SF-36. J Health Econ 21:271–292PubMedCrossRefGoogle Scholar
  8. 8.
    Popay J, Roberts H, Sowden A, Petticrew A, Arai L, Rodgers M, Britten N. (2006) Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. A Product from the ESRC Methods Programme. Ref Type: ReportGoogle Scholar
  9. 9.
    Cooper C, Jakob F, Chinn C, Martin-Mola E, Fardeloone P, Adami S, Thalassinos NC, Melo-Gomes J, Torgerson D, Gibson A, Marin F (2009) Fracture incidence and changes in quality of life in women with inadequate clinical outcome from osteoporosis therapy: the Observational Study of Severe Osteoporosis (OSSO). Osteoporosis International (in press)Google Scholar
  10. 10.
    Czoski-Murray C, De-Nigris E, Brazier J, Walters S (2007) A prospective controlled study of the costs and health related quality of life following hip fracture. School of Health and Related Research, University of SheffieldGoogle Scholar
  11. 11.
    Zethraeus N, Borgström F, Johnell O, Kanis J, Önnby K, Jönsson B. (2002) Costs and Quality of life Associated with Osteoporosis related Fractures—Results from a Swedish Survey SSE/EFI. 2002. Working Paper Series in Economics and Finance, No 512. Ref Type: ReportGoogle Scholar
  12. 12.
    Rajzbaum G, Jakob F, Karras D, Ljunggren O, Lems W, Langdahl B, Fahrleitner-Pammer A, Walsh J, Gibson A, Tynan A, Marin F (2008) Characterization of patients in the European Forsteo Observational Study (EFOS): postmenopausal women entering teriparatide treatment in a community setting. Curr Med Res Opin 24(2):377–384PubMedCrossRefGoogle Scholar
  13. 13.
    Ariza-Ariza R, Hernández-Cruz B, Navarro Sarabia F (2004) Calidad de vida de los pacientes con osteoporosis. Validación de la versión en español de un instrumento específico: el OPTQoL. Rev Esp Reumatol 31(2):74–81Google Scholar
  14. 14.
    Blomfeldt R, Tornkvist H, Ponzer S, Soderqvist A, Tidermark J (2005) Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. randomized, controlled trial performed at four years. J Bone Joint Surg Am 87(8):1680–1688PubMedCrossRefGoogle Scholar
  15. 15.
    Cockerill W, Lunt M, Silman AJ, Cooper C, Lips P, Bhalla AK, Cannata JB, Eastell R, Felsenberg D, Gennari C, Johnell O, Kanis JA, Kiss C, Masaryk P, Naves M, Poor G, Raspe H, Reid DM, Reeve J, Stepan J, Todd C, Woolf AD, O’Neill TW (2004) Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15:113–119PubMedCrossRefGoogle Scholar
  16. 16.
    Hall SE, Criddle RA, Comito TL, Prince RL (1999) A case-control study of quality of life and functional impairment in women with long-standing osteoporotic fracture. Osteoporos Int 9:508–515PubMedCrossRefGoogle Scholar
  17. 17.
    Tidermark J, Zethraeus N, Svensson O, T&ouml rnkvist H, Ponzer S (2002) Femoral neck fractures in the elderly: functional outcome and quality of life according to EuroQol. Qual Life Res 11:473–481PubMedCrossRefGoogle Scholar
  18. 18.
    Tidermark J, Zethraeus N, Svensson O, Tornkvist H, Ponzer S (2003) Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. J Orthop Trauma 17(8 SUPPLEMENT):S17–S21PubMedCrossRefGoogle Scholar
  19. 19.
    Soderqvist RN, Miedel R, Ponzer S, Tidermark J (2006) The influence of cognitive function on outcome after hip fracture. J Bone Joint Surgery 88-A(10):2115–2123CrossRefGoogle Scholar
  20. 20.
    Tosteson A-NA (2001) Impact of hip and vertebral fractures on quality—adjusted life years. Osteoporos Int 12:1042–1049 Ref Type: GenericPubMedCrossRefGoogle Scholar
  21. 21.
    van Schoor NM, Ewing SK, O, Neil TW, Hunt M, Smit JH, Lips P (2008) Impact of prevalent and incident vertebral fractures on utility: results from a patient-based and population-based sample. Qual Life Res 17:159–267PubMedCrossRefGoogle Scholar
  22. 22.
    Brazier JE, Kohler B, Walters S. (2000) A prospective study of health related quality of life impact of hip fracture. Sheffield: ScHARR. University of Sheffield. .Ref Type: Unpublished WorkGoogle Scholar
  23. 23.
    Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Mineral Res 15(7):1384–1392CrossRefGoogle Scholar
  24. 24.
    Jakob F, Marin F, Martin-Mola E, Torgerson D, Fardellone P, Adami S, Thalassinos NC, Sykes D, Melo-Gomes J, Chinn C, Nicholson T, Cooper C (2006) Characterization of patients with an inadequate clinical outcome from osteoporosis therapy: the Observational Study of Severe Osteoporosis (OSSO). Qjm 99(8):531–543PubMedCrossRefGoogle Scholar
  25. 25.
    Kind P, Hardman G, Macran S. (1999) UK population norms for EQ-5D. 172. University of York. CHE discussion paper. Ref Type: ReportGoogle Scholar
  26. 26.
    Prescott-Clarke P, Primatesta P. (1998) Health Survey for England 1996. London, HMSO. Ref Type: ReportGoogle Scholar
  27. 27.
    Burström K, Johannesson M, Diderichsen F (2001) Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 10:621PubMedCrossRefGoogle Scholar
  28. 28.
    Fryback DG, Dasbach EJ, Dorn N, Martin PA (1993) The beaver dam health outcomes study: initial catalog of health-state quality factors. Med Decis Mak 13:89–102CrossRefGoogle Scholar
  29. 29.
    Fryback DG, Martin PA, Lawrence WF, Klein R, Klein BE (1997) Predicting quality of well-being scores from the sf-36: results from the beaver dam health outcomes study. Med Decis Mak 17:1–9CrossRefGoogle Scholar
  30. 30.
    Sullivan PW, Ghushchyan V (2006) Preference-based eq-5d index scores for chronic conditions in the united states. Med Decis Mak 26:410–420CrossRefGoogle Scholar
  31. 31.
    Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15:20–26PubMedCrossRefGoogle Scholar
  32. 32.
    Gabriel SE, Kneeland TS, Melton LJ, Moncur MM, Ettinger B, Tosteson A (1999) Health-related quality of life in economic evaluations for osteoporosis: whose values should we use. Med Decis Mak 19:141–148CrossRefGoogle Scholar
  33. 33.
    Sawka AM, Thabane L, Papaioannou A, Gafni A, Ioannidis G, Papadimitropoulos EA, Hopman WM, Cranney A, Hanley DA, Pickard L, Adachi JD, CaMos I (2005) Health-related quality of life measurements in elderly Canadians with osteoporosis compared to other chronic medical conditions: a population-based study from the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 16(12):1836–1840PubMedCrossRefGoogle Scholar
  34. 34.
    Dhillon V, Hurst N, Hannan J, Nuki G (2005) Association of low general health status, measured prospectively by Euroqol EQ5D, with osteoporosis, independent of a history of prior fracture. Osteoporos Int 16(5):483–489PubMedCrossRefGoogle Scholar
  35. 35.
    Dennison EM, Syddall HE, Statham C, Aihie Sayer A, Cooper C (2006) Relationships between SF-36 health profile and bone mineral density: the Hertfordshire Cohort Study. Osteoporos Int 17:1435–1442PubMedCrossRefGoogle Scholar
  36. 36.
    Martin AR, Sornay-Rendu E, Chandler JM, uboeuf F, Girman CJ, Delmas PD (2002) The impact of osteoporosis on quality-of-life: The OFELY cohort. Bone 31(1):32–36PubMedCrossRefGoogle Scholar
  37. 37.
    Badia X, Ez-Perez A, Varez-Sanz C, Az-Lopez B, Az-Curiel M, Guillen F, Gonzalez-Macias J, Spanish GRECO Study Group (2001) Measuring quality of life in women with vertebral fractures due to osteoporosis: a comparison of the OQLQ and QUALEFFO. Qual Life Res 10(4):307–317PubMedCrossRefGoogle Scholar
  38. 38.
    van Schoor NM, Smit JH, Twisk JW, Lips P (2005) Impact of vertebral deformities, osteoarthritis, and other chronic diseases on quality of life: a population-based study. Osteoporos Int 16(7):749–756PubMedCrossRefGoogle Scholar
  39. 39.
    Yoh K, Tanaka K, Ishikawa A, Ishibashi T, Uchino Y, Sato Y, Tobinaga M, Hasegawa N, Kamae S, Yoshizawa M (2005) Health-related quality of life (HRQOL) in Japanese osteoporotic patients and its improvement by elcatonin treatment. J Bone Mineral Metab 23(2):167–173CrossRefGoogle Scholar
  40. 40.
    Adachi JD, Loannidis G, Berger C, Joseph L, Papaioannou A, Pickard L, Papadimitropoulos EA, Hopman W, Poliquin S, Prior JC, Hanley DA, Olszynski WP, Anastassiades T, Brown JP, Murray T, Jackson SA, Tenenhouse A, Canadian Multicentre Osteoporosis Study (CaMos) Research Group (2001) The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada. Osteoporos Int 12(11):903–908PubMedCrossRefGoogle Scholar
  41. 41.
    Cranney A, Coyle D, Pham BA, Tetroe J, Wells G, Jolly E, Tugwell P (2001) The psychometric properties of patient preferences in osteoporosis. J Rheumatol 28(1):132–137PubMedGoogle Scholar
  42. 42.
    Fechtenbaum J, Cropet C, Kolta S, Horlait S, Orcel P, Roux C (2005) The severity of vertebral fractures and health-related quality of life in osteoporotic postmenopausal women. Osteoporos Int 16:2175–2179PubMedCrossRefGoogle Scholar
  43. 43.
    Silverman SL, Minshall ME, Shen W, Harper KD, Xie S, on behalf of the Health-Related Quality of Life Subgroup of the Multiple Outcomes of Raloxifene Evaluation Study (2001) The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis. Results from the Multiple Outcomes of Raloxifene Evaluation Study. Arthritis and Rheumatism 44(11):2611–2619PubMedCrossRefGoogle Scholar
  44. 44.
    Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, Svensson O, Abdon P, Ornstein E, Lunsjo K, Thorngren KG, Sernbo I, Rehnberg C, Jonsson B (2006) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 17(5):637–650PubMedCrossRefGoogle Scholar
  45. 45.
    Salkeld G, Cameron ID, Cumming RG, Easter S, Seymour J, Kurrle SE, Quine S (2003) Quality of life related to fear of falling and hip fracture in older women: a time trade-off study. Bri Med J 320:241–246 Ref Type: AbstractGoogle Scholar
  46. 46.
    Czoski-Murray C, De-Nigris E, Brazier J, Walters S (2007) A prospective controlled study of the costs and health related quality of life following hip fracture. School of Health and Related Research, University of Sheffield. 1–12, Ref Type: Personal CommunicationGoogle Scholar
  47. 47.
    Dolan P, Torgerson D, Kumar Kalarlapudi TK (1999) Health related quality of life of Colles′ fracture patients. Osteoporos Int 9:196–199PubMedCrossRefGoogle Scholar
  48. 48.
    Adachi JD, Ioannidis G, Pickard L, Berger C, Prior JC, Joseph L, Hanley DA, Olszynski WP, Murray TM, Anastassiades T, Hopman W, Brown JP, Kirkland S, Joyce C, Papaioannou A, Poliquin S, Tenenhouse A, Papadimitropoulos EA (2003) The association between osteoporotic fractures and health-related quality of life as measured by the Health Utilities Index in the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 14(11):895–904PubMedCrossRefGoogle Scholar
  49. 49.
    Kaukonen J-P, Karaharju EO, Porras M, Luthje P, Jakobsson A (1998) Functional recovery after fracture of the distal forearm. Ann Chir Gynaecol 77:27–31Google Scholar
  50. 50.
    Bickerstaff DR, Kanis JA (1994) Algodystrophy: An under-recognized complication of minor trauma. Bri J Rheumatol 33:240–248CrossRefGoogle Scholar
  51. 51.
    Atkins RM, Duckworth T, Kanis JA (1990) features of algodystrophy after Colles’s fracture. J Bone Joint Surg Am 72-B(1):105–110Google Scholar
  52. 52.
    Merlino LA, Bagchi I, Taylor TN, Utrie P, Chrischilles E, Sumner W, Mudano A, Saag KG (2001) Arthritis Patients Preferences for Fractures and Other Glucocorticoid-Associated Adverse Effects among Rheumatoid. Med Decis Mak 21:122–132Google Scholar
  53. 53.
    Read JL, Quinn RJ, Berwick DM, Fineberg HV, Weinstein MC (1984) Preferences for health outcomes: comparison of assessment methods. Medi Decis Mak 4:315–329CrossRefGoogle Scholar
  54. 54.
    Stiggelbout AM, Eijkemans MJ, Kiebert GM, Kievit J, Leer JW, De Haes HJ (1996) The “utility” of the visual analog scale in medical decision making and technology assessment: is it an alternative to the time trade-off. Int J Technol Assess Health Care 12:291–298PubMedCrossRefGoogle Scholar
  55. 55.
    Dolan P, Sutton M (1997) Mapping visual analogue scale health state valuations onto standard gamble and time trade-off values. Soc Sci Med 44:1519–1530PubMedCrossRefGoogle Scholar
  56. 56.
    Golicki D, Sliwka A, Fijewski G, Latek M (2006) Quality of life according to EQ-5D after osteoporotic hip fracture in Poland. Value Health 9(6):A382–A383Google Scholar
  57. 57.
    Briggs AH, Gray AM (1999) Handling uncertainty when performing economic evaluation of health care interventions. Health Technol Assess 3:No.2Google Scholar
  58. 58.
    Strom O, Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, Svensson O, Abdon P, Ornstein E, Ceder L, Thorngren KG, Sernbo I, Jonsson B (2008) Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden. Acta Orthop 79:269–280PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • T. Peasgood
    • 1
  • K. Herrmann
    • 1
  • J. A. Kanis
    • 2
  • J. E. Brazier
    • 1
    Email author
  1. 1.Health Economics and Decision Science, School of Health and Related ResearchUniversity of Sheffield Regent CourtSheffieldUK
  2. 2.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK

Personalised recommendations