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An Updated Systematic Review of Cost-Effectiveness Analyses of Drugs for Osteoporosis


  • Nannan Li

    (Maastricht University)

  • Dennis Cornelissen

    (Maastricht University)

  • Stuart Silverman

    (UCLA School of Medicine and the OMC Clinical Research Center)

  • Daniel Pinto

    (Marquette University)

  • Lei Si

    (The George Institute for Global Health, UNSW Sydney
    Nanjing Medical University)

  • Ingrid Kremer

    (Maastricht University)

  • Sandrine Bours

    (Maastricht University)

  • Robin de Bot

    (Maastricht University
    Maastricht University Medical Center)

  • Annelies Boonen

    (Maastricht University)

  • Silvia Evers

    (Maastricht University)

  • Joop van den Bergh

    (VieCuri, Medical Centre
    NUTRIM, Maastricht University Medical Centre
    University Hasselt)

  • Jean-Yves Reginster

    (University of Liège)

  • Mickaël Hiligsmann

    (Maastricht University)


Background Considering the heavy economic burden of osteoporotic fractures, the limits of healthcare resources, and the recent availability of new anti-osteoporosis drugs, there is continuing interest in economic evaluation studies of osteoporosis management strategies. Objectives This study aims to (1) systematically review recent economic evaluations of drugs for osteoporosis and (2) to apply an osteoporosis-specific guideline to critically appraise them. Methods A literature search was undertaken using PubMed, EMBASE, National Health Service Economic Evaluation database, and the Cost-Effectiveness Analysis Registry to identify original articles containing economic evaluations of anti-osteoporosis drugs, published between 1 July, 2013 and 31 December, 2019. A recent European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases-International Osteoporosis Foundation (ESCEO-IOF) guideline for the conduct and reporting of economic evaluations in osteoporosis was used to assess the quality of included articles. Results The database search retrieved 3860 records, of which 27 studies fulfilled the inclusion criteria. These studies were conducted in 15 countries; 12 active drugs were assessed, including various traditional pharmacological treatments such as bisphosphonates, raloxifene, strontium ranelate, denosumab, and teriparatide, and new agents such as abaloparatide, romosozumab, and gastro-resistant risedronate. Eight out of 12 studies that compared traditional oral bisphosphonates to other active interventions (denosumab, zoledronic acid, gastro-resistant risedronate, and teriparatide) suggested that the other active agents were generally cost-effective or dominant. Additionally, the cost-effectiveness of sequential therapy has recently been assessed and indications are that it can lead to extra health benefits (larger gains in quality-adjusted life-year). The key drivers of cost effectiveness included baseline fracture risk, drug effect on the risk of fractures, drug cost, and medication adherence/persistence. The current average score for quality assessment was 17 out of 25 (range 2–15); room for improvement was observed for most studies, which could potentially be explained by the fact that most studies were published prior to the osteoporosis-specific guideline. Greater adherence to guideline recommendations was expected for future studies. The quality of reporting was also suboptimal, especially with regard to treatment side effects, treatment effect after discontinuation, and medication adherence. Conclusions This updated review provides an overview of recently published cost-effectiveness analyses. In comparison with a previous review, recent economic evaluations of anti-osteoporosis drugs were conducted in more countries and included more active drugs and sequential therapy as interventions/comparators. The updated economic evidence could help decision makers prioritize health interventions and the unmet/unreported quality issues indicated by the osteoporosis-specific guideline could be useful in improving the transparency, quality, and comparability of future economic evaluations in osteoporosis.

Suggested Citation

  • Nannan Li & Dennis Cornelissen & Stuart Silverman & Daniel Pinto & Lei Si & Ingrid Kremer & Sandrine Bours & Robin de Bot & Annelies Boonen & Silvia Evers & Joop van den Bergh & Jean-Yves Reginster & , 2021. "An Updated Systematic Review of Cost-Effectiveness Analyses of Drugs for Osteoporosis," PharmacoEconomics, Springer, vol. 39(2), pages 181-209, February.
  • Handle: RePEc:spr:pharme:v:39:y:2021:i:2:d:10.1007_s40273-020-00965-9
    DOI: 10.1007/s40273-020-00965-9

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    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 15th March 2021
      by Chris Sampson in The Academic Health Economists' Blog on 2021-03-15 12:00:14

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