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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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13CA071

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