Challenges for model-based economic evaluations of postmenopausal osteoporosis interventions

Assessing the cost-effectiveness of long-term treatment for osteoporosis re quires use of mathematical models to estimate health effects and costs for competing interventions. The primary motivations for model-based analyses i nclude the lack of long-term clinical trial outcome data and the lack of da ta comparing all relevant treatments within randomized clinical trials. We report on specific modeling challenges that arose in the development of a m odel of the natural history of postmenopausal osteoporosis that is suitable for assessing the cost-effectiveness of osteoporosis interventions among v arious population subgroups in diverse countries. These include choice of m odeling changes in bone mineral density (BMD) or in fracture rate, definiti on of health states, modeling mortality and costs of long-term care followi ng fracture, incorporation of health utility, and model validation. This re port should facilitate future postmenopausal osteoporosis model development and provide insight for decisionmakers who must evaluate model-based econo mic analyses of postmenopausal osteoporosis interventions.