Osteoporosis International

, Volume 25, Issue 1, pp 325–337 | Cite as

Comparative cost-effectiveness of bazedoxifene and raloxifene in the treatment of postmenopausal osteoporosis in Europe, using the FRAX algorithm

  • K. KimEmail author
  • A. Svedbom
  • X. Luo
  • S. Sutradhar
  • J. A. Kanis
Original Article



Bazedoxifene and raloxifene were evaluated in the treatment of postmenopausal osteoporosis from health economic perspective in Europe. Based on a computer-based algorithm calculating efficacy of the treatments, bazedoxifene appears to be a cost-effective strategy compared to raloxifene, particularly in patients at high fracture risk.


The purpose of this study was to compare cost-effectiveness of bazedoxifene and raloxifene in eight European countries: Belgium, France, Germany, Ireland, Italy, Spain, Sweden, and the UK.


The Fracture Risk Assessment Tool, which is a computer-based algorithm to calculate fracture probability using clinical risk factors alone or with bone mineral density, was incorporated in a Markov Tunnel model to evaluate cost-effectiveness of bazedoxifene 20 or 40 mg vs. raloxifene 60 mg in postmenopausal osteoporotic women. The efficacy of bazedoxifene and raloxifene for vertebral and non-vertebral fractures was measured as a function of the 10-year probability of a major osteoporotic fracture. The model estimated the incremental cost-effectiveness ratio and net monetary benefit (NMB) from a healthcare perspective, given the willingness to pay €30,000.


In postmenopausal osteoporotic women, bazedoxifene was a cost saving strategy compared to raloxifene in the countries studied. The median NMB of bazedoxifene compared to raloxifene increased monotonically with the 10-year fracture probability. In general, the median NMB became greater than 0 in women with 10-year probabilities of a major osteoporotic fracture between 5 and 10 % or above. The impact on results by varying the assumptions in the model was examined in sensitivity analysis.


Bazedoxifene appears to be a cost-effective strategy compared to raloxifene for the treatment of postmenopausal osteoporotic women in Europe, particularly in patients at high fracture risk.


Bazedoxifene Cost-effectiveness Fracture FRAX Osteoporosis Raloxifene 



This study was sponsored by Pfizer. Kun Kim and Axel Svedbom are employees of OptumInsight, who were paid consultants to Pfizer in connection with the development of this manuscript. The economic modeling and validation work was performed at OptumInsight, and OptumInsight is also responsible for the data storage.

Conflicts of interest

Xuemei Luo is an employee of Pfizer, and Santosh Sutradhar was an employee of Pfizer at the time this work was conducted. As employees of OptumInsight, Kun Kim and Axel Svedbom have provided consultancy services to numerous companies involved in the marketing of treatment for osteoporosis.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • K. Kim
    • 1
    Email author
  • A. Svedbom
    • 1
    • 2
  • X. Luo
    • 3
  • S. Sutradhar
    • 4
  • J. A. Kanis
    • 5
  1. 1.OptumInsightStockholmSweden
  2. 2.Unit of Dermatology; Department of MedicineKarolinska InstitutetSolnaSweden
  3. 3.Pfizer, Inc.GrotonUSA
  4. 4.PfizerNew YorkUSA
  5. 5.University of Sheffield Medical SchoolSheffieldUK

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