Age-specific mortality rates were obtained from the National Institute of Statistics. According to data from a recent meta-analysis [4], hip fractures increased male death probabilities by 5.75 in the first 6 months following the fracture, by 2.315 in the period 6–12 months and by 1.691 in subsequent years. As

the increased mortality following clinical vertebral fractures has been found in many studies to be very similar than those of a hip CB-839 fracture [26–29], the same impact was assumed after hip and clinical vertebral fractures. To avoid an overestimation of the beneficial effect of treatment on mortality, it is important to take GDC973 only into account excess mortality that are directly or indirectly attributable to the fractures themselves [30], which could be reduced through fracture prevention. Because excess mortality Idasanutlin purchase may also be attributable to comorbidities, we assumed in the model only 25 % of the excess mortality after fractures [28, 31]. A healthcare payer perspective including direct medical costs was adopted for all cost estimates, as recommended for pharmacoeconomic evaluations in Belgium [32]. Following the guideline, direct

healthcare costs paid by the national health insurance and patient’s out-of pocket costs were included [32]. All costs were expressed in the year 2010 using the healthcare product price index when necessary, and discount rates of 3 % for costs and of 1.5 % for health benefits were assumed for the base-case analysis also based on the Belgian guideline for pharmacoeconomic evaluations [32]. The direct hospitalisation cost of hip fracture, Cell press administrated in the first cycle following the fracture, was retrieved from the Belgian national database of hospital bills for the year 2007 [33]. It included the social security cost and the patient out-of-pocket contribution for nursing and residential fees costs only. Extra costs in the year following the hip fracture were derived from the study

of Autier et al. [34], which based on a prospective controlled study including 159 women. These costs, estimated at €8,001 (expressed in €2,010), were equally distributed between the two first cycles following the fracture. Hip fractures are also associated with long-term costs. They were based on the proportion of men being institutionalized following the fracture, ranging from 6 % (for men aged 60 years) to 65 % (for those aged over 90 years) [35]. Because men might be institutionalized later in life, regardless of their hip fracture, an adjustment was made to only include long-term costs attributable to the fracture itself (see Hiligsmann et al. [18] for further explanations). The cost of non-hip fractures has never been estimated in Belgian men and these were quantified relative to hip fracture cost [36]. So, the costs of clinical vertebral, wrist and other fracture represent 17.4 %, 14.5 % and 17.4 % of the hip fracture cost, respectively.