Cost effectiveness of secondary vs tertiary prevention for post-menopausal osteoporosis

Background: The aging of the population is likely to increase the number of osteoporosis-related fractures, such as hip fractures, and hence the economic burden for society. Therefore, strategies to identify women at increased risk are of major interest. Objective: The aim of this study was to determine the cost effectiveness of preventive services for osteoporosis, comparing secondary plus tertiary prevention (SP/TP) versus tertiary prevention (TP) alone in post-menopausal women in Germany. Methods: A cost-utility analysis and a budget-impact analysis were performed from the perspective of the German statutory health insurance (SHI). A Markov model simulated costs and benefits discounted at 3% over a lifetime horizon. Results: Cost effectiveness of TP compared with no screening was €669, €477 and €385 per QALY for women aged 60, 70 and 80 years, respectively (year 2010 values). In women aged 50 years, TP dominated no prevention. Cost effectiveness of SP/TP compared with TP was €4543, €19 791, €8670 and €3368 for women aged 50, 60, 70 and 80 years, respectively. SP/TP resulted in additional costs of €109 million or 0.10% of the SHIs annual budget (TP alone = €8 million). Conclusion: Compared with TP, a strategy based on SP/TP appears to be more expensive but more effective in each age group. Given that cost effectiveness seems acceptable, allocation of resources to SP/TP to decrease postmenopausal osteoporotic fracture risk may be justified. © 2011 Adis Data Information BV. All rights reserved.