(2) whether alternative treatments are available on the NHS to patients at risk of osteoporotic fracture who do not respond to the first line treatment prescribed by their general practitioner;
(3) what estimate he has made of the cost of (a) treating an osteoporotic hip fracture and (b) providing treatments likely to prevent such fractures from occurring in the latest period for which figures are available.
The Department has made no estimate of the overall cost to the national health service of treating patients with osteoporotic fractures. Nor has the Department estimated the individual cost of treating an osteoporotic hip fracture, or the cost of providing treatments to prevent osteoporotic fractures.
In its appraisal of the use of bisphosphonates in post-menopausal women, which was published in 2005, the National Institute for Health and Clinical Excellence (NICE) estimated that among post-menopausal women, the cost to the NHS of fractures to the hip, forearm and spine was £942 million. Additionally, draft final guidance issued by NICE on 26 June 2007, acknowledged that the cost of treating post-menopausal women with Alendronate, the recommended therapy for both the initiation of primary and secondary prevention of osteoporotic fractures, would be between £95.03 and £301.39 per patient per year.
This new set of guidance, which NICE expects to publish in final form in August 2007, covers the initiation of treatment only. The future NICE clinical guideline on osteoporosis will cover the treatment of women who cannot take or have withdrawn from treatment with Alendronate. Until this guideline is published, we expect NHS organisations to continue to provide treatments based on an assessment of the available evidence.
The National Institute for Health and Clinical Excellence (NICE) has issued a Final Appraisal Determination on treatments to prevent osteoporotic fractures in post-menopausal women. This is a particularly complex appraisal and has taken longer to complete than would normally be the case. NICE operates a robust appraisal process, involving a full assessment of the evidence and public consultation on its draft recommendations. It is important that in the most complex cases, NICE is allowed to take sufficient time to ensure that final guidance it issues is of a high quality.