Osteoporosis International

, Volume 22, Issue 3, pp 955–965

Cost-effectiveness of bazedoxifene incorporating the FRAX® algorithm in a European perspective

  • F. Borgström
  • O. Ström
  • M. Kleman
  • E. McCloskey
  • H. Johansson
  • A. Odén
  • J. A. Kanis
Original Article

DOI: 10.1007/s00198-010-1291-5

Cite this article as:
Borgström, F., Ström, O., Kleman, M. et al. Osteoporos Int (2011) 22: 955. doi:10.1007/s00198-010-1291-5

Abstract

Summary

The cost-effectiveness of bazedoxifene was compared to placebo in France, Germany, Italy, Spain, Sweden and the UK from a healthcare perspective using FRAX® for both fracture risks and for treatment efficacy. Cost/QALY differences were explained to a large extent by differences in fracture risk.

Introduction

In cost-effectiveness modelling of osteoporosis treatments, the fracture risk has traditionally been calculated with risk adjustments based on age, bone mineral density and prior fracture. However, knowledge of additional clinical risk factors contributes to fracture risk assessment as demonstrated by the FRAX® tool. Bazedoxifene, a new selective estrogen receptor modulator for the treatment and prevention of osteoporosis, has been shown in a phase III clinical trial to reduce the risk of osteoporotic fractures in women. In an analysis using FRAX®, the efficacy of bazedoxifene was greater in patients with higher fracture risk.

Methods

The aim of this study was to evaluate the cost-effectiveness of bazedoxifene compared to placebo in France, Germany, Italy, Spain, Sweden and the UK from a healthcare perspective using FRAX®. A Markov cohort model was adapted to incorporate the FRAX® risk factors. FRAX® produces relative risks for hip fractures and major osteoporotic fractures. Patients were given a 5-year intervention, reducing the risk of fractures in a risk-dependent manner. The effect of treatment on fractures was assumed to decline linearly over 5 years after the intervention.

Results

There are large cost/quality-adjusted life year variations between countries in the European setting studied. The base case values ranged from cost saving (Sweden) to EUR 105,450 (Spain) in 70-year-old women with a T-score of −2.5 SD and a prior fracture.

Conclusion

Bazedoxifene can be a cost-effective treatment for postmenopausal osteoporosis. The variability between countries was explained to a large extent by differences in fracture risk, and the estimated cost-effectiveness was highly dependent on the population’s FRAX®-estimated probability of major osteoporotic fracture.

Keywords

Clinical risk factor Efficacy Fracture Osteoporosis Risk SERM 

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • F. Borgström
    • 1
    • 2
    • 5
  • O. Ström
    • 1
    • 2
  • M. Kleman
    • 1
  • E. McCloskey
    • 3
  • H. Johansson
    • 4
  • A. Odén
    • 4
  • J. A. Kanis
    • 4
  1. 1.StockholmSweden
  2. 2.LIME/MMCKarolinska InstitutetStockholmSweden
  3. 3.Osteoporosis CentreNorthern General HospitalSheffieldUK
  4. 4.WHO Collaborating CentreUniversity of SheffieldSheffieldUK
  5. 5.StockholmSweden

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