A health economic simulation model for the clinical management of osteoporosis
The objective was to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice. Results showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings.
The purpose of this study is to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice.
The analysis was carried out using a model that simulates the individual patients considered for pharmacological treatment during 1 year and their projected osteoporosis treatment pathway, quality-adjusted life years (QALYs) and costs over their remaining lifetime. All patients regardless of treatment or no treatment were simulated. Information on current management of osteoporosis in terms of patient characteristics and treatment patterns were derived from a Swedish osteoporosis research database based on national registers and patient records. Current (standard) clinical management was compared with alternative scenarios mirroring Swedish treatment guidelines.
The national burden in terms of lost QALYs was estimated at 14,993 QALYs and the total economic cost at €776M. Scenario analyses showed that 382–3864 QALYs could be gained at a cost/QALY ranging from cost-saving to €31368, depending on the scenario. The margin of investment, i.e. the maximum amount that could be invested in the healthcare system to achieve these improvements up to the limit of the willingness to pay/QALY, was estimated at €199M on a population level (€3,634/patient).
The analysis showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings. From a cost-effectiveness perspective, there is also considerable room for investment to achieve these improvements in the management of osteoporosis.
KeywordsCost Fracture Osteoporosis Quality-of-life Register Sweden
The authors gratefully acknowledge the guidance of the Epidemiology and Quality of Life Working Group of the Committee of Scientific Advisors of the International Osteoporosis Foundation. The study was financed with an unrestricted grant from Medtronic.
Compliance with ethical standards
Conflicts of interest
EJ, AH and FB have previously consulted for companies marketing products for osteoporosis. ÖJ, AS, KÅ, JK declare that they have no conflict of interest.
This research was approved by Stockholm ethics vetting committee decision 2013/1543-31/4.
- 1.Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos International, 2006(0937-941X (Print))Google Scholar
- 2.Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8(1-2):136. https://doi.org/10.1007/s11657-013-0136-1 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Strom O et al (2011) Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 6(1-2):59–155. https://doi.org/10.1007/s11657-011-0060-1 CrossRefPubMedGoogle Scholar
- 13.Statistics Sweden Ettårig livslängdstabell, dödsrisker (promille) efter kön, ålder och år [One year life expectancy, mortality (per mille) by sex, age and year]. 2015, Statistics Sweden: http://www.statistikdatabasen.scb.se/sq/20061
- 19.Tandvårds- och Läkemedelsförmånsverket (The Dental and Pharmaceutical Benefits Agency), Läkemedelsförmånsnämndens allmänna råd om ekonomiska utvärderingar in TLVAR 2017:1, T.-o. Läkemedelsförmånsverket, Editor. 2017Google Scholar
- 21.The Dental and Pharmaceutical Benefits Agency (TLV), Läkemedelsdatabas. 2016, The Dental and Pharmaceutical Benefits AgencyGoogle Scholar
- 22.Södra Regionvårdsnämnden, Regionala priser och ersättningar för södra sjukvårdsregionen 2016. 2015Google Scholar
- 23.Statistics Sweden, Consumer price index (1980=100) [online database]. 2016: http://www.scb.se/hitta-statistik/statistik-efter-amne/priser-och-konsumtion/konsumentprisindex/konsumentprisindex-kpi/
- 24.The Riksbank, Search interest & exchange rate [online database], Riksbanken (Sweden's central bank), editor. 2016: http://www.riksbank.se/en/Interest-and-exchange-rates/search-interest-rates-exchange-rates/
- 25.Zethraeus, N., et al., Costs and quality of life associated with osteoporosis related fractures—results from a Swedish survey. N. SSE/EFI Working Paper Series in Economics and Finance, Editor. 2002Google Scholar
- 27.National Institute for Health and Care Excellence (NICE), Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women. 2008Google Scholar
- 28.Läkemedelsverket (Medical Products Agency), Behandling av osteoporos för att förebygga frakturer–Behandlingsrekommendation. 2004Google Scholar
- 30.Socialstyrelsen (National Board of Health and Welfare), Nationella riktlinjer för sjukdomsförebyggande metoder 2011 Hälsoekonomiskt underlag [National guidelines for disease prevention methods 2011]. 2011Google Scholar
- 31.Socialstyrelsen (National Board of Health and Welfare), Nationella riktlinjer för rörelseorganens sjukdomar 2012. 2012Google Scholar
- 34.McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L, Adekunle F, Roberts D (2011) Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 22(7):2083–2098. https://doi.org/10.1007/s00198-011-1534-0 CrossRefPubMedGoogle Scholar