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Osteoporosis in the European Union: medical management, epidemiology and economic burden
(EU-27 Report)
EU Osteoporosis Consultation Panel Meeting – 27 November 2013
Prof Juliet Compston
International Osteoporosis Foundation (IOF)European Federation of Pharmaceutical Industry Associations (EFPIA)
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis
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Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis
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HOW MANY PEOPLE IN THE EU HAVE OSTEOPOROSIS?
2010 Figures / Over age 50 / Based on WHO diagnostic criteria (T-score less than or equal to -2.5SD)
NEW FRACTURES IN EU IN 2010
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 4
Total number of incident fractures in 2010 – 3.5 million
HIP FRACTURE – A MAJOR BURDEN IN COSTS, DISABILITY, EARLY DEATH
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 5
Hip fracture incidence/100,000 in men and women above 50 years
standardized to the EU27 population
MORTALITY DUE TO FRACTURE
42,000 deaths in 2010 directly attributable to fractures within the first year
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 6
Proportion of deaths due to fracture by site
HIGH COST BURDEN OF OSTEOPOROSIS
Cost of osteoporosis is €37 billion
Direct costs of treating fractures =66%Long-term fracture care = 29%Prevention = 5%
Despite enormous costs to care for fractures, only 5% is spent on prevention
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 7
HIP FRACTURES ARE MOST COSTLY
Hip fractures represent 54% of the costs
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 8
Others; 39%
Forearm; 2%
Spine; 5%
Hip; 54%
BURDEN OF FRACTURES IN 2010
Estimated number of life-years lost in the EU due to fractures is 26,300
Total health burden is estimated at 1,180,000 QALYS for EU (QALY=quality-adjusted life year)
Total value of QALYs lost is estimated at €61.4 billion
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 9
QALYS LOST BY NEW AND PRIOR FRACTURES
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 10
Prior vertebral fractures
16%
Incident hip fractures
12%
Incident vertebral fractures
14%
Incident forearm fractures
1%
Incident «other» fractures
17%
Prior hip fractures
40%
FRACTURE BURDEN TO RISE BY 22% WITH AGEING OF POPULATION
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 11
2010 2025 % increasePeople with osteoporosis
27.5 million 33.9 million 23
Number of fractures 3.5 million 4.5 million 28Number of QALYs 1.2 million 1.4 million 20Total cost 98 billion € 121 billion € 22
UPTAKE OF OSTEOPOROSIS TREATMENTS Since 2001, considerable increase of the treatment
uptake, but slight decrease recently Alendronate is the most prescribed drug (~ a quarter of the total
value of sales)
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Sales in €/100 population
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis
UPTAKE OF OSTEOPOROSIS TREATMENTS
Uptake of individual treatments differs between regions. Usually Southern Europe has a higher uptake
An example with Ibandronate
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Northern Europe Southern Europe
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis
LARGE TREATMENT GAP NEEDS TO BE ADDRESSED
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis
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Conservative estimate:
Only 59% of men and 57% of women are treated compared to the proportion of the population that could be considered eligible for treatment based on their fracture risk.
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Service uptake – treatment gap
Treatment gap (%)
0
20
40
60
80
100
Sp
ain
Ireland
Hu
ng
ary
Greece
Po
rtug
al
Fran
ce
Lu
xemb
ou
rg
Slo
venia
Belg
ium
Slo
vakia
Au
stria
Den
mark
UK
Italy
Neth
erland
s
Fin
land
Sw
eden
Czech
Germ
any
Po
land
Ro
man
ia
Latvia
Esto
nia
Lith
uan
ia
Bu
lgaria
EU
27
Moderate
High
Very high
PROBLEMS IDENTIFIED
Approved treatments (BPs, SrR, Rlx, Dmab, PTH) are widely available, but their use is restricted by reimbursement policies and guidelines
Compliance and persistence to treatments are poor
Marked variation in DXA availability between countries
Need for fracture liaison services for secondary prevention of fractures
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 16
MEDICAL INNOVATION – WE HAVE THE EVIDENCE AND THE TOOLS…. Fracture prevention with alendronate is cost-effective
Other treatments are cost-effective compared to no treatment
BMD assessment is an essential tool for diagnosis, risk prediction and targeting for treatment, and monitoring of treatment
FRAX model estimates the probability of fracture and available for 16 countries – and numbers are growing
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 17
Thank you
Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis 18