A systematic review of cost-effectiveness analyses of drugs for postmenopausal osteoporosis.
BACKGROUND
Given the limited availability of healthcare resources and the recent introduction of new anti-osteoporosis drugs, the interest in the cost effectiveness of drugs in postmenopausal osteoporosis remains and even increases.


OBJECTIVE
This study aims to identify all recent economic evaluations on drugs for postmenopausal osteoporosis, to critically appraise the reporting quality, and to summarize the results.


METHODS
A literature search using Medline, the National Health Service Economic Evaluation database and the Cost-Effectiveness Analysis Registry was undertaken to identify original articles published between January 1, 2008 and December 31, 2013. Studies that assessed cost effectiveness of drugs in postmenopausal osteoporosis were included. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to assess the quality of reporting of these articles.


RESULTS
Of 1,794 articles identified, 39 studies fulfilled the inclusion criteria. They were conducted in 14 different countries and nine active interventions were assessed. When compared with no treatment, active osteoporotic drugs were generally cost effective in postmenopausal women aged over 60-65 years with low bone mass, especially those with prior vertebral fractures. Key drivers of cost effectiveness included individual fracture risk, medication adherence, selected comparators and country-specific analyses. Quality of reporting varied between studies with an average score of 17.9 out of 24 (range 7-21.5).


CONCLUSIONS
This review found a substantial number of published cost-effectiveness analyses of drugs in osteoporosis in the last 6 years. Results and critical appraisal of these articles can help decision makers when prioritizing health interventions and can inform the development of future economic evaluations.
Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands, m.hiligsmann@maastrichtuniversity.nl.
Mickaël
M
Hiligsmann
Silvia M
SM
Evers
Wafa
W
Ben Sedrine
John A
JA
Kanis
Bram
B
Ramaekers
Jean-Yves
JY
Reginster
Stuart
S
Silverman
Caroline E
CE
Wyers
Annelies
A
Boonen
D000368:Aged; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000191:economics; D058866:Osteoporotic Fractures / Q000191:economics / Q000517:prevention & control*; D012306:Risk
D050071:Bone Density Conservation Agents