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Cost-effectiveness of the treatment and prevention of osteoporosis—a review of the literature and a reference model

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Abstract

Objective

The purpose of the paper is to update and review the latest developments related to modelling and economic evaluation of osteoporosis in the period 2002–2005 and further to present a reference model for the assessment of the cost-effectiveness of the prevention and treatment of osteoporosis.

Discussion

The reference model is intended to be used for fracture specific interventions affecting the risk of fracture. An interface version and an extensive description of the model is available on the internet (http://www.healtheconomics.se) and also accessible via the International Osteoporosis Foundation (http://www.osteofound.org). The purpose of the reference model is to improve the quality and comparability of cost-effectiveness analysis in the osteoporosis field and to serve as a tool for validation of present and future cost-effectiveness models. The reference model allows the cost-effectiveness analysis to be carried out from a societal perspective including intervention, morbidity and mortality costs. The model has been extensively tested and calibrated, and meets the properties of good decision analytic modelling. The model is a state transition Markov cohort model, which is characterised by a 50-year time horizon divided into one year cycle lengths. The following health states are included: “healthy”, “hip fracture”, “spine fracture”, “wrist fracture”, “other fracture”, and “dead”.

Conclusion

The model is flexible and allows for the estimation of the cost-effectiveness over different ranges for a selected number of variables (e.g., age, fracture risk, cost of intervention).

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References

  1. Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473

    Article  PubMed  CAS  Google Scholar 

  2. SBU [The Swedish Council on Technology Assessment in Health Care] (2003) Osteoporos-prevention, diagnostik och behandling [Osteoporosis-prevention, diagnosis and treatment]. SBU, Stockholm, report No 165/1

    Google Scholar 

  3. Zethraeus N, Borgström F, Johnell O, Jönsson B (2002) Costs and quality of life associated with osteoporosis related fractures-results based on a Swedish survey. Published in the Working Paper Series in Economics and Finance at the Stockholm School of Economics, Working paper No 512

  4. Borgström F, Zethraeus N, Johnell O (2005) Costs and quality of life associated with osteoporosis related fractures in Sweden. Osteopoprosis International (forthcoming 2005)

  5. 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 15:20–26

    Article  PubMed  CAS  Google Scholar 

  6. Sawka AM, Boulos P, Beattie K, Thabane L, Papaioannou A, Gafni A, Cranney A, Zytaruk N, Hanley DA, Adachi JD (2005) Do hip protectors decrease the risk of hip fracture in institutional and community-dwelling elderly? A systematic review and meta-analysis of randomized controlled trials. Osteoporos Int

  7. Total läkemedelsförsäljning (2000–2004) In: Apoteket (ed)

  8. Eberhardt S, Stoklossa C, Schulenburg JGvd (2005) Euromet 2004. The influence of economic evaluation studies on health care decision making. A European Study. In: Eberhardt S, Stoklossa C, Graf von der Schulenburg JM (eds). Amsterdam, The Netherlands

  9. Fleurence RL, Iglesias CP, Torgerson DJ (2005) Economic evaluations of interventions for the prevention and treatment of osteoporosis: a structured review of the literature. Osteoporos Int

  10. Johannesson M, Jonsson B (1993) Economic evaluation of osteoporosis prevention. Health Policy 24:103–124

    Article  PubMed  CAS  Google Scholar 

  11. Zethraeus N, Ben Sedrine W, Caulin F, Corcaud S, Gathon HJ, Haim M, Johnell O, Jonsson B, Kanis JA, Tsouderos Y, Reginster JY (2002) Models for assessing the cost-effectiveness of the treatment and prevention of osteoporosis. Osteoporos Int 13:841–857

    Article  PubMed  CAS  Google Scholar 

  12. Tosteson AN, Jonsson B, Grima DT, O’Brien BJ, Black DM, Adachi JD (2001) Challenges for model-based economic evaluations of postmenopausal osteoporosis interventions. Osteoporos Int 12:849–857

    Article  PubMed  CAS  Google Scholar 

  13. Weinstein MC (1980) Estrogen use in postmenopausal women-costs, risks, and benefits. N Engl J Med 303:308–316

    Article  PubMed  CAS  Google Scholar 

  14. Weinstein MC, Schiff I (1983) Cost-effectiveness of hormone replacement therapy in the menopause. Obstet Gynecol Surv 38:445–455

    Article  PubMed  CAS  Google Scholar 

  15. Weinstein MC, Tosteson AN (1990) Cost-effectiveness of hormone replacement. Ann N Y Acad Sci 592:162–172, discussion 185–192

    Article  PubMed  CAS  Google Scholar 

  16. Tosteson AN, Rosenthal DI, Melton LJ 3rd, Weinstein MC (1990) Cost effectiveness of screening perimenopausal white women for osteoporosis: bone densitometry and hormone replacement therapy. Ann Intern Med 113:594–603

    PubMed  CAS  Google Scholar 

  17. Tosteson AN, Weinstein MC (1991) Cost-effectiveness of hormone replacement therapy after the menopause. Baillieres Clin Obstet Gynaecol 5:943–959

    Article  PubMed  CAS  Google Scholar 

  18. Jönsson B, Hedbrant J, Johnell O (1993) A Computer Simulation Model to Analyse the Cost-effectiveness of Fracture Prevention of Osteoporosis. EFI Research paper Nr 6525

  19. Zethraeus N, Johannesson, M, Jönsson, B (1998) A computer model to analyse the cost effectiveness of hormone replacement therapy. EFI Research Paper No 6578

  20. Zethraeus N, Lindgren P, Johnell O (2000) A computer model to analyse the cost-effectiveness of hormone replacement therapy-a revised version. SSE/EFI Working Paper Series in Economics and Finance, at the Stockholm School of Economics, Working paper No 368

  21. Jonsson B, Kanis J, Dawson A, Oden A, Johnell O (1999) Effect and offset of effect of treatments for hip fracture on health outcomes. Osteoporos Int 10:193–199

    Article  PubMed  CAS  Google Scholar 

  22. Zethraeus N, Johannesson M, Jonsson B (1999) A computer model to analyze the cost-effectiveness of hormone replacement therapy. Int J Technol Assess Health Care 15:352–365

    PubMed  CAS  Google Scholar 

  23. Johnell O, Jonsson B, Jonsson L, Black D (2003) Cost effectiveness of alendronate (fosamax) for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics 21:305–314

    Article  PubMed  Google Scholar 

  24. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. Jama 288:321–333

    Article  PubMed  CAS  Google Scholar 

  25. Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, Bonds D, Brunner R, Brzyski R, Caan B, Chlebowski R, Curb D, Gass M, Hays J, Heiss G, Hendrix S, Howard BV, Hsia J, Hubbell A, Jackson R, Johnson KC, Judd H, Kotchen JM, Kuller L, LaCroix AZ, Lane D, Langer RD, Lasser N, Lewis CE, Manson J, Margolis K, Ockene J, O’Sullivan MJ, Phillips L, Prentice RL, Ritenbaugh C, Robbins J, Rossouw JE, Sarto G, Stefanick ML, Van Horn L, Wactawski-Wende J, Wallace R, Wassertheil-Smoller S (2004) Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. Jama 291:1701–1712

    Article  PubMed  CAS  Google Scholar 

  26. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E (1998) Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. Jama 280:605–613

    Article  PubMed  CAS  Google Scholar 

  27. Melton LJ 3rd, Kan SH, Wahner HW, Riggs BL (1988) Lifetime fracture risk: an approach to hip fracture risk assessment based on bone mineral density and age. J Clin Epidemiol 41:985–994

    Article  PubMed  Google Scholar 

  28. Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ 3rd, O’Neill T, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194

    Article  PubMed  Google Scholar 

  29. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Bmj 312:1254–1259

    PubMed  CAS  Google Scholar 

  30. Bagger YZ, Tanko LB, Alexandersen P, Hansen HB, Qin G, Christiansen C (2005) The long-term predictive value of bone mineral density measurements for fracture risk is independent of the site of measurement and the age at diagnosis: results from the Prospective Epidemiological Risk Factors study. Osteoporos Int 1–7

  31. Meltzer D (1997) Accounting for future costs in medical cost-effectiveness analysis. J Health Econ 16:33–64

    Article  PubMed  CAS  Google Scholar 

  32. Gold M, Siegel, J, Russell, L (1996) Cost-effectiveness in health and medicine. Oxford University Press, New York

    Google Scholar 

  33. Borgstrom F, Johnell O, Jonsson B, Zethraeus N, Sen SS (2004) Cost effectiveness of alendronate for the treatment of male osteoporosis in Sweden. Bone 34:1064–1071

    Article  PubMed  Google Scholar 

  34. Borgstrom F, Johnell O, Kanis JA, Oden A, Sykes D, Jonsson B (2004) Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden: an economic evaluation based on the MORE study. Pharmacoeconomics 22:1153–1165

    Article  PubMed  Google Scholar 

  35. Brecht JG, Kruse HP, Felsenberg D, Mohrke W, Oestreich A, Huppertz E (2003) Pharmacoeconomic analysis of osteoporosis treatment with risedronate. Int J Clin Pharmacol Res 23:93–105

    PubMed  CAS  Google Scholar 

  36. Brecht JG, Kruse HP, Mohrke W, Oestreich A, Huppertz E (2004) Health-economic comparison of three recommended drugs for the treatment of osteoporosis. Int J Clin Pharmacol Res 24:1–10

    PubMed  CAS  Google Scholar 

  37. Christensen PM, Brixen K, Gyrd-Hansen D, Kristiansen IS (2005) Cost-effectiveness of alendronate in the prevention of osteoporotic fractures in Danish women. Basic Clin Pharmacol Toxicol 96:387–396

    Article  PubMed  CAS  Google Scholar 

  38. Fleurence RL (2004) Cost-effectiveness of fracture prevention treatments in the elderly. Int J Technol Assess Health Care 20:184–191

    Article  PubMed  Google Scholar 

  39. Grima, Burge, Tosteson (2002) Short-term cost-effectiveness of bisphosphonate therapies for postmenopausal osteoporotic somen at high risk of fracture. 27:448–455

  40. Iglesias CP, Torgerson DJ, Bearne A, Bose U (2002) The cost utility of bisphosphonate treatment in established osteoporosis. Qjm 95:305–311

    Article  PubMed  CAS  Google Scholar 

  41. Jonsson L, Borgstrom F, Zethraeus N (2003) [Cost-effectiveness of alendronate treatment of osteoporosis in Denmark. An economic evaluation based on the Fracture Intervention Trial]. Ugeskr Laeger 165:4112–4116

    PubMed  Google Scholar 

  42. Kanis JA, Borgstrom F, Johnell O, Jonsson B (2004) Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women. Osteoporos Int 15:862–871

    Article  PubMed  CAS  Google Scholar 

  43. Kanis JA, Borgstrom F, Johnell O, Oden A, Sykes D, Jonsson B (2005) Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study. Osteoporos Int 16:15–25

    Article  PubMed  CAS  Google Scholar 

  44. Kanis JA, Brazier JE, Stevenson M, Calvert NW, Lloyd Jones M (2002) Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 6:1–146

    PubMed  CAS  Google Scholar 

  45. Lundkvist J, Johnell O, Cooper C, Sykes D (2005) Economic evaluation of parathyroid hormone (PTH) in the treatment of osteoporosis in postmenopausal women. Osteoporos Int

  46. Nagata-Kobayashi S, Shimbo T, Fukui T (2002) Cost-effectiveness analysis of screening for osteoporosis in postmenopausal Japanese women. J Bone Miner Metab 20:350–357

    Article  PubMed  Google Scholar 

  47. Schousboe JT, Nyman JA, Kane RL, Ensrud KE (2005) Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med 142:734–741

    PubMed  Google Scholar 

  48. Segui-Gomez M, Keuffel E, Frick KD (2002) Cost and effectiveness of hip protectors among the elderly. Int J Technol Assess Health Care 18:55–66

    PubMed  Google Scholar 

  49. Singh S, Sun H, Anis AH (2004) Cost-effectiveness of hip protectors in the prevention of osteoporosis related hip fractures in elderly nursing home residents. J Rheumatol 31:1607–1613

    PubMed  Google Scholar 

  50. Stevenson M, Lloyd Jones M, De Nigris E, Brewer N, Davis S, Oakley J (2005) A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. Health Technol Assess 9:1–160

    PubMed  CAS  Google Scholar 

  51. Waldegger L, Cranney A, Man-Son-Hing M, Coyle D (2003) Cost-effectiveness of hip protectors in institutional dwelling elderly. Osteoporos Int 14:243–250

    PubMed  Google Scholar 

  52. Willis MS (2002) The health economics of calcium and vitamin D3 for the prevention of osteoporotic hip fractures in Sweden. Int J Technol Assess Health Care 18:791–807

    Article  PubMed  Google Scholar 

  53. Zethraeus N, Borgstrom F, Jonsson B, Kanis J (2005) Reassessment of the cost-effectiveness of hormone replacement therapy in Sweden: Results based on the Women’s Health Initiative randomized controlled trial. Int J Technol Assess Health Care 21:433–441

    Article  PubMed  Google Scholar 

  54. Borgstrom F, Zethraeus N (2003) [Economic assessment based on a clinical study of risedronate. Fracture prevention in elderly women with osteoporosis is cost-effective]. Lakartidningen 100:36–40

    PubMed  Google Scholar 

  55. Johannesson M, Hedbrant J, Jonsson B (1991) A computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention. Med Inform (Lond) 16:355–362

    CAS  Google Scholar 

  56. Kanis JA, Johnell O, Oden A, Borgstrom F, Johansson H, De Laet C, Jonsson B (2005) Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden. Osteoporos Int 16:6–14

    Article  PubMed  Google Scholar 

  57. Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674

    Article  PubMed  CAS  Google Scholar 

  58. Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561

    Article  PubMed  CAS  Google Scholar 

  59. Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882

    Article  PubMed  CAS  Google Scholar 

  60. Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ 3rd (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005

    PubMed  CAS  Google Scholar 

  61. Jalava T, Sarna S, Pylkkanen L, Mawer B, Kanis JA, Selby P, Davies M, Adams J, Francis RM, Robinson J, McCloskey E (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1260

    Article  PubMed  Google Scholar 

  62. Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112

    Article  PubMed  Google Scholar 

  63. Parker MJ, Anand JK (1991) What is the true mortality of hip fractures? Public Health 105:443–446

    Article  PubMed  CAS  Google Scholar 

  64. Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42

    Article  PubMed  CAS  Google Scholar 

  65. Oden A, Dawson A, Dere W, Johnell O, Jonsson B, Kanis JA (1998) Lifetime risk of hip fractures is underestimated. Osteoporos Int 8:599–603

    Article  PubMed  CAS  Google Scholar 

  66. Statistics Sweden. Sweden’s Statistical Databases. In http://wwwscbse/eng/databaser/ssdasp

  67. Zethraeus N, Borgström F, Johnell O, Kanis J, Jönsson B (2002) Costs and Quality of Life Associated with Osteoporosis Related Fractures-Results from a Swedish Survey. Working Paper Series in Economics and Finance, 512

  68. Burstrom K, Johannesson M, Diderichsen F (2001) Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 10:621–635

    Article  PubMed  CAS  Google Scholar 

  69. Kind P, Dolan P, Gudex C, Williams A (1998) Variations in population health status: results from a United Kingdom national questionnaire survey. Br Med J 316:736–741

    CAS  Google Scholar 

  70. Jonsson B, Christiansen C, Johnell O, Hedbrandt J, Karlsson G (1996) Cost-effectiveness of fracture prevention in established osteoporosis. Scand J Rheumatol Suppl 103:30–38

    Article  PubMed  CAS  Google Scholar 

  71. 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 Miner Res 15:1384–1392

    Article  PubMed  CAS  Google Scholar 

  72. Zethraeus N, Stromberg L, Jonsson B, Svensson O, Ohlen G (1997) The cost of a hip fracture. Estimates for 1,709 patients in Sweden. Acta Orthop Scand 68:13–17

    Article  PubMed  CAS  Google Scholar 

  73. Stockholms stads budgetavräkning 2003 [online]. In

  74. Ekman M, Zethraeus N, Dahlstrom U (2002) Cost-effectiveness of bisoprolol in chronic heart failure. Lakartidningen 99(7):646–650

    PubMed  Google Scholar 

  75. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541

    Article  PubMed  CAS  Google Scholar 

  76. Lauritzen JB, Petersen MM, Lund B (1993) Effect of external hip protectors on hip fractures. Lancet 341:11–13

    Article  PubMed  CAS  Google Scholar 

  77. McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, Adami S, Fogelman I, Diamond T, Eastell R, Meunier PJ, Reginster JY (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340

    Article  PubMed  CAS  Google Scholar 

  78. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. Jama 282:637–645

    Article  PubMed  CAS  Google Scholar 

  79. WHO (1999) Recommendations for health economics evaluations of interventions in osteoporosis. WHO Collaborating Centre for Public Health Aspects of Osteoporosis and other Rheumatic Diseases, Liège, Belgium

    Google Scholar 

  80. LFN [the Swedish drug benefits board]. General guidelines for the economic evaluation from pharmaceutical benefits board. LFNAR 2003:2

  81. Zethraeus N, Johannesson M, Henriksson P, Strand RT (1997) The impact of hormone replacement therapy on quality of life and willingness to pay. Br J Obstet Gynaecol 104:1191–1195

    PubMed  CAS  Google Scholar 

  82. Daly E, Gray A, Barlow D, McPherson K, Roche M, Vessey M (1993) Measuring the impact of menopausal symptoms on quality of life. Bmj 307:836–840

    Article  PubMed  CAS  Google Scholar 

  83. Akehorst RPA, Brazier J (2000) Decision analytic modelling in the economic evaluation of health technologies. A consensus statement. Pharmacoeconomics 17:443–444

    Article  Google Scholar 

  84. Sculpher M, Fenwick E, Claxton K (2000) Assessing quality in decision analytic cost-effectiveness models. A suggested framework and example of application. Pharmacoeconomics 17:461–477

    Article  PubMed  CAS  Google Scholar 

  85. Briggs AH (2000) Handling uncertainty in cost-effectiveness models. Pharmacoeconomics 17:479–500

    Article  PubMed  CAS  Google Scholar 

  86. Johannesson M (2001) At what coronary risk level is it cost-effective to initiate cholesterol lowering drug treatment in primary prevention? Eur Heart J 22:919–925

    Article  PubMed  CAS  Google Scholar 

  87. Almbrand B, Johannesson M, Sjostrand B, Malmberg K, Ryden L (2000) Cost-effectiveness of intense insulin treatment after acute myocardial infarction in patients with diabetes mellitus; results from the DIGAMI study. Eur Heart J 21:733–739

    Article  PubMed  CAS  Google Scholar 

  88. National Osteoporosis Foundation (1998) Osteoporosis: Review of the Evidence for Prevention, Diagnosis and Treatment and Cost-Effective Analysis. Osteoporosis International 8(Suppl 4):1–88

    Google Scholar 

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Acknowledgements

Supported in part by a grant from the International Osteoporosis Foundation.

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Authors and Affiliations

  1. Centre for Health Economics, Stockholm School of Economics, P.O. Box 6501, S-113 83, Stockholm, Sweden

    N. Zethraeus & B. Jönsson

  2. Stockholm Health Economics, Vasagatan 38 2tr, SE-111 20, Stockholm, Sweden

    F. Borgström & O. Ström

  3. Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, UK, Sheffield, S10 2RX, UK

    J. A. Kanis

  4. Medical Management Centre at the Karolinska Institute (KI), Stockholm, Sweden

    F. Borgström

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  1. N. Zethraeus
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  2. F. Borgström
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  3. O. Ström
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  4. J. A. Kanis
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  5. B. Jönsson
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Correspondence to J. A. Kanis.

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The named authors wrote this article on behalf of the Committee of Scientific Advisors of the International Osteoporosis Foundation.

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Zethraeus, N., Borgström, F., Ström, O. et al. Cost-effectiveness of the treatment and prevention of osteoporosis—a review of the literature and a reference model. Osteoporos Int 18, 9–23 (2007). https://doi.org/10.1007/s00198-006-0257-0

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