Non-hip fracture costs were also restricted to acute hospitalization cost but care typically extend beyond this (e.g., drugs, doctors, home care). Taking indirect costs such as productivity losses and other care costs into account would improve the cost-effectiveness of strontium ranelate as sensitivity analysis showed that cost-effectiveness improved with higher fracture costs. Conservative assumption was also used for the costs of vertebral fractures as they were calculated from a relationship between fractures in 1995 [36], and treatment of vertebral fractures has become more expensive in recent years due to an increasing

number of surgical GSK3 inhibitor click here procedures [63]. Finally, the generalizability of our results to other settings may be uncertain since the incidence of the disease, the availability of health resources, clinical practice patterns and relative prices may substantially differ between countries

and could impact on the cost-effectiveness [64]. Cost-effectiveness analysis should ideally be performed in each specific country with local data. However, it is likely that strontium ranelate will also confer cost-effective benefits, compared with no treatment, in countries with similar characteristics than those retained in this analysis. In conclusion, under the assumption of the same relative risk reduction of fractures in men as for women, this cost-effectiveness analysis suggests that strontium ranelate

has the potential to be a cost-effective strategy compared with no treatment next for men with osteoporosis from a healthcare payer perspective. Acknowledgments This work was supported by an unrestricted educational grant from Servier, which had no role in the design or conduct of the study, in the collection, analysis, or interpretation of the data. Conflicts of interest Mickaël Hiligsmann: research grant, lecture fees and/or consulting fees from Amgen, Pfizer, Novartis, Servier and SMB. Olivier Bruyère: consulting fees, lecture fees and reimbursement for attending meetings from Servier, GlaxoSmithKline, MSD, Theramex, Galapagos, Rottarpham. Jean-Yves Reginster: consulting fees or paid advisory boards, Servier, Novartis, Negma, Ely Lilly, Wyeth, Amgen, GlaxoSmithKline, Roche, Merkle, Nycomed, NPS, Theramex; lecture fees when speaking from Merck Sharp and Dohme, Eli Lilly, Rottapharm, IBSA, Genevrier, Novartis, Servier, Roche, GlaxoSmithKline, Teijin, Teva, Ebewee Pharma, Zodiac, Analis, Theramex, Nycomed, Novo-Nordisk; grant support from Bristol Myers Squibb, Merck Sharp & Dhome, Rottapharm, Teva, Eli Lilly, Novartis, Roche, GlaxoSmithKline, Amgen, and Servier. Wafa Ben Sedrine has no conflict of interests.