Review Article

Economic Evaluation of Denosumab for Treatment of Postmenopausal Osteoporosis: A Systematic Review


Background: We aimed to review the systematic economic evaluation of denosumab versus than alternative drugs and oral bisphosphonates of postmenopausal osteoporosis in women and help health system policy makers for prioritizing and optimally allocate limited health resources.

Methods: We examined the databases of PubMed, Web of Science, Embase, Scopus, Cochrane Library, ProQuest. Strategy search was designed based on keywords. Inclusion criteria were: studies that conducted economic evaluation denosumab compared to oral bisphosphonates for the treatment of osteoporosis in postmenopausal women. Cost-effectiveness studies conducted using decision analysis models based on the economic evaluation approach; studies with available full-text papers; and studies written in English and published between 2010 and 2020. After selecting articles based on inclusion and exclusion criteria, data were extracted and the results were summarized. The quality of the articles was evaluated using the CHEERS checklist.

Results: Among 214 initial studies, 8 studies met the inclusion criteria. Most studies focused on the cost-effectiveness of denosumab compared with oral bisphosphonates for the treatment of osteoporosis. The study agreed interval ranged from 3 months to 5 years. The costs investigated in the studies were direct medical costs. In most studies, the use of denosumab significantly prevented fractures.

Conclusion: Denosumab is generally more cost-effective than alternative drugs and oral bisphosphonates (alendronate, risedronate, strontium ranelate, ibandronate, and untreated).


1. Rashki kemmak A, Reazpour A, Jahangiri R, et al (2020). Economic burden of osteo-porosis in the world: A systematic review. Med J Islam Repub Iran, 34: 154.
2. Naghavi M, Abolhassani F, Pourmalek F, et al (2009). The burden of disease and inju-ry in Iran 2003. Popul Health Metr, 7:9.
3. Hodsman A, Papaioannou A, Cranney A (2006). Clinical practice guidelines for the use of parathyroid hormone in the treat-ment of osteoporosis. CMAJ,175(1):48.
4. Dempster DW (2011). Osteoporosis and the burden of osteoporosis-related frac-tures. Am J Manag Care, 6:S164-9.
5. Bangemann T (2005). Shared Services in Finance and Accounting. Gower Publishing Limited.
6. Hernlund E, Svedbom A, Ivergård M, et al (2013). Osteoporosis in the European Union: medical management, epidemiol-ogy and economic burden. Arch Osteopo-ros, 8(1):136.
7. Irani AD, Poorolajal J, Khalilian A, et al (2013). Prevalence of osteoporosis in Iran: A meta-analysis. J Res Med Sci, 18(9): 759–766.
8. Jönsson B, Ström O, Eisman JA, et al (2011). Cost-effectiveness of denosumab for the treatment of postmenopausal os-teoporosis. Osteoporos Int, 22(3):967-82.
9. Chisholm D, Evans DB (2007). Economic evaluation in health: saving money or im-proving care? Journal of Medical Economics, 10(3):325-337.
10. Fox-Rushby J, Cairns J (2005). Economic eval-uation: McGraw. Hill Education (UK), pp:101-123
11. Kemmak AR, Abutorabi A, Alipour V (2020). Economic Evaluation of Rivarox-aban Versus Enoxaparin for Prevention of Venous Thromboembolism After To-tal Knee Replacement and Total Hip Re-placement: A Systematic Review. Clin Drug Investig, 40(8):715-725.
12. Darbà J, Kaskens L, Vilela FS, et al (2015). Cost-utility of denosumab for the treat-ment of postmenopausal osteoporosis in Spain. Clinicoecon Outcomes Res,10(7):105-17.
13. Chau D, Becker DL, Coombes ME, et al (2012). Cost-effectiveness of denosumab in the treatment of postmenopausal os-teoporosis in Canada. J Med Econ, 1(15):3-14.
14. Hiligsmann M, Reginster JY (2011). Cost ef-fectiveness of denosumab compared with oral bisphosphonates in the treat-ment of post-menopausal osteoporotic women in Belgium. Pharmacoeconomics, 29(10):895-911.
15. Mori T, Crandall CJ, Ganz DA (2017). Cost-effectiveness of denosumab versus oral alendronate for elderly osteoporotic women in Japan. Osteoporos Int, 1 (5):1733-1744.
16. Parthan A, Kruse M, Yurgin N, et al (2013). Cost effectiveness of denosumab versus oral bisphosphonates for postmenopau-sal osteoporosis in the US. Appl Health Econ Health Policy, 11(5):485-97.
17. Pongchaiyakul C, Nanagara R, Songpata-nasilp T, et al (2020). Cost-effectiveness of denosumab for high-risk postmeno-pausal women with osteoporosis in Thai-land. J Med Econ, 2 (23):776-785.
18. Yoshizawa T, Nishino T, Okubo I, et al (2018). Cost-effectiveness analysis of drugs for osteoporosis treatment in el-derly Japanese women at high risk of fra-gility fractures: comparison of denosum-ab and weekly alendronate. Arch Osteopo-ros,13(1):94.
19. Clynes MA, Harvey NC, Curtis EM, et al (2020). The Epidemiology of Osteoporo-sis. Br Med Bull, 133(1):105-117.
20. Leder BZ, Tsai JN, Uihlein AV, et al(2014). Two years of denosumab and teriparatide administration in postmenopausal women with osteoporosis (The DATA Extension Study): a randomized controlled trial. J Clin Endocrinol Metab, 99(5):1694-700.
21. Cummings SR, San Martin J, McClung MR, et al (2009). Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med, 361(8):756-65.
22. Aalabaf‐Sabaghi M (2007). Decision model-ling for health economic evaluation. J Ep-idemiol Community Health, 61(9):839.
23. Drummond MF, Sculpher MJ, Claxton K, et al (2015). Methods for the economic evaluation of health care programmes. Oxford university press, pp:231-236.
IssueVol 51 No 7 (2022) QRcode
SectionReview Article(s)
Cost benefit analysis Denosumab Osteoporosis Postmenopausal Systematic review

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Nargesi S, Husseini Barghazan S, Sani’ee N, Rashki Kemmak A. Economic Evaluation of Denosumab for Treatment of Postmenopausal Osteoporosis: A Systematic Review. Iran J Public Health. 2022;51(7):1502-1512.