REVIEW An updated systematic review of Health State Utility Values for osteoporosis related conditions T. Peasgood & K. Herrmann & J. A. Kanis & J. E. Brazier Received: 15 September 2008 / Accepted: 15 December 2008 / Published online: 7 March 2009 # International Osteoporosis Foundation and National Osteoporosis Foundation 2009 Abstract Introduction An important component of cost effectiveness models in the field of osteoporosis is the set of Health State Utility Values (HSUVs) used for key fracture outcomes. This paper presents a review of HSUVs for key osteopo- rotic states (hip, wrist, shoulder, clinical, and morphometric vertebral fractures, established osteoporosis, and interaction of several fractures). It provides an update to the systematic review conducted by Brazier et al. (Osteoporos Int 13 (10):768–776, 2002). Materials and methods A systematic search was undertak- en of the main literature databases for HSUVs for established osteoporosis, vertebral, hip, wrist, and shoulder fractures were identified. Studies meeting the inclusion criteria were reviewed in terms of the patient population, the method of describing health (if not obtained directly from patients), the method of valuing health states and the source of values. Results Estimates of Health State Utility Values were found across the osteoporosis conditions from 27 studies. A wide range of empirical estimates were found, partly due to differences in valuation technique (VAS, SG, TTO), descriptive system and differences in respondents (popula- tion or patient), the perspective of the task (own health or a scenario), sample size, and study quality. Conclusion The paper provides a set of multipliers repre- senting the loss in HSUVs for use as a “reference case” in cost-effectiveness models. Keywords Health State Utility Values . Osteoporosis . Quality adjusted life years . Utilities Introduction An important component of cost effectiveness models in the field of osteoporosis is the values used for key fracture outcomes. The cost effectiveness of an intervention is expressed in terms of the incremental cost per quality adjusted life year (QALY), where the QALY combines increased life expectancy and improvements in health status. QALYs are estimated by assigning a value to health states experienced by patients following the intervention on a scale from 0 to 1, where 1 corresponds to full health and zero to states regarded as bad as being dead (and negative values to states worse than being dead). Cost-effectiveness models require Health State Utility Values (HSUVs) for key osteoporotic outcomes such as hip and vertebral factures. With a growing literature of HSUVs in osteoporosis, there is the question of which values should be used in a model. There are a number of methods for deriving utility values for economic evaluation [3], either by expert opinion (authors or expert panels) or empirically. This review is only concerned with the latter. There are a number of empirical methods for deriving HSVs. One is to directly Osteoporos Int (2009) 20:853–868 DOI 10.1007/s00198-009-0844-y Electronic supplementary material The online version of this article (doi:10.1007/s00198-009-0844-y) contains supplementary material, which is available to authorized users. T. Peasgood : K. Herrmann : J. E. Brazier (*) Health Economics and Decision Science, School of Health and Related Research, University of Sheffield Regent Court, Court, 30 Regent Street, Sheffield, UK S1 4DA e-mail: j.e.brazier@shef.ac.uk J. A. Kanis WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Beech Hill Road, Sheffield, UKS10 2RX