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Osteoporosis in the European Union: medical management, epidemiology and economic burden

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

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Osteoporosis in the European Union: medical management, epidemiology and economic burden

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  1. 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)

  2. Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis

  3. HOW MANY PEOPLE IN THE EU HAVE OSTEOPOROSIS? 2010 Figures / Over age 50 / Based on WHO diagnostic criteria (T-score lessthan or equal to -2.5SD) Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis

  4. new fractures in EU IN 2010 Total number of incident fractures in 2010 – 3.5 million 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 – A MAJOR BURDEN IN COSTS, DISABILITY, EARLY DEATH Hip fracture incidence/100,000 in men and womenabove 50 years standardized to the EU27 population Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis

  6. Mortality due to fracture • 42,000 deaths in 2010 directly attributable to fractures within the first year Proportion of deaths due to fracture by site Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis

  7. high costburdenof 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

  8. Hip fractures are mostcostly • Hip fractures represent 54% of the costs Others; 39% Forearm; 2% Hip; 54% Spine; 5% Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis

  9. 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

  10. QALYslost by new and prior fractures Incident vertebral fractures 14% Incident forearm fractures 1% Incident «other» fractures 17% Prior vertebral fractures 16% Prior hip fractures 40% Incident hip fractures 12% Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis

  11. 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

  12. Uptake of osteoporosistreatments • 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) 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

  13. Uptake of osteoporosistreatments • Uptake of individual treatments differs between regions. Usually Southern Europe has a higher uptake • An example with Ibandronate 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

  14. large Treatment Gap needs to beaddressed 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. Herlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Archives of Osteoporosis

  15. Treatment gap (%) 100 Very high 80 High 60 Moderate 40 13ca071 20 Service uptake – treatment gap 0 UK Italy EU27 Spain Latvia Czech Ireland Poland France Austria Greece Finland Estonia Belgium Sweden Bulgaria Portugal Slovakia Hungary Slovenia Romania Lithuania Denmark Germany Netherlands Luxembourg

  16. Problemsidentified • 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

  17. 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

  18. Thank you 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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