Cost-utility of drug treatment in the secondary prevention of fragility fractures: a regional study
Abstract
Objectives: Fractures due to bone fragility are a major cause of morbidity and mortality. This study aimed to assess the cost-effectiveness of secondary prevention of these fractures using real-world data from the Basque population.
Methods: A retrospective observational study was conducted, including individuals aged 60 years and over with fragility fractures of the wrist, humerus or vertebrae. The study used a cost-effectiveness design, incorporating individual-level data on costs and quality-adjusted life years (QALYs). The two groups were balanced using a propensity score (entropy balance). Both the study follow-up period and the patient’s entire lifetime were analysed. The latter was obtained by adding comorbidity-adjusted life expectancy to the follow-up period via extrapolation based on survival analysis. The incremental cost-effectiveness ratio (ICER) was calculated for each group, and variability was analysed using bootstrapping, cost-effectiveness plots and acceptability curves. The incremental net benefit was also calculated using regression models.
Results: A total of 33,569 patients were included in the study, of whom 12,833 had wrist fractures, 12,586 had vertebral fractures and 8,150 had fractures of the humerus. Of these patients, 20.12% were treated, with different percentages for vertebral (32.34%), wrist (14.46%) and humerus (10.17%) cases. The incremental cost-effectiveness ratio following the use of the propensity score was €720 per QALY gained over the follow-up period, and €270 per QALY gained when extrapolated. Similar results were obtained from the bootstrapping and incremental net benefit analyses.
Discussion: The ICER for the three types of fracture analysed is well below Spain’s defined acceptability threshold of around €23,000/QALY. This implies that secondary prevention should continue as a public health policy, with efforts being made to increase the proportion of patients treated.
Key messages: • Secondary prevention of fragility fractures is a cost-effective public health policy.
• More effort should be made to increase the proportion of patients who are treated.
Related
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- Hip Structural Analysis and Multiple Fragility Fractures: Evidence from a Large Cross-Sectional Clinical Cohort.
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BibTeX
@article{mar2026costutility,
title = {{Cost-utility of drug treatment in the secondary prevention of fragility fractures: a regional study}},
author = {J Mar and O Ibarrondo and I Etxebarria-Foronda},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1077},
url = {https://doi.org/10.1093/eurpub/ckag169.1077},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Cost-utility of drug treatment in the secondary prevention of fragility fractures: a regional study
AU - J Mar
AU - O Ibarrondo
AU - I Etxebarria-Foronda
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1077
UR - https://doi.org/10.1093/eurpub/ckag169.1077
AB - Objectives: Fractures due to bone fragility are a major cause of morbidity and mortality. This study aimed to assess the cost-effectiveness of secondary prevention of these fractures using real-world data from the Basque population. Methods: A retrospective observational study was conducted, including individuals aged 60 years and over with fragility fractures of the wrist, humerus or vertebrae. The study used a cost-effectiveness design, incorporating individual-level data on costs and quality-adjusted life years (QALYs). The two groups were balanced using a propensity score (entropy balance). Both the study follow-up period and the patient’s entire lifetime were analysed. The latter was obtained by adding comorbidity-adjusted life expectancy to the follow-up period via extrapolation based on survival analysis. The incremental cost-effectiveness ratio (ICER) was calculated for each group, and variability was analysed using bootstrapping, cost-effectiveness plots and acceptability curves. The incremental net benefit was also calculated using regression models. Results: A total of 33,569 patients were included in the study, of whom 12,833 had wrist fractures, 12,586 had vertebral fractures and 8,150 had fractures of the humerus. Of these patients, 20.12% were treated, with different percentages for vertebral (32.34%), wrist (14.46%) and humerus (10.17%) cases. The incremental cost-effectiveness ratio following the use of the propensity score was €720 per QALY gained over the follow-up period, and €270 per QALY gained when extrapolated. Similar results were obtained from the bootstrapping and incremental net benefit analyses. Discussion: The ICER for the three types of fracture analysed is well below Spain’s defined acceptability threshold of around €23,000/QALY. This implies that secondary prevention should continue as a public health policy, with efforts being made to increase the proportion of patients treated. Key messages: • Secondary prevention of fragility fractures is a cost-effective public health policy. • More effort should be made to increase the proportion of patients who are treated.
SN - 1101-1262
SN - 1464-360X
ER -