Objective: To evaluate the cost-utility of drug treatment for fracture prevention in Thai postmenopausal women with osteoporosis without fracture history, considering adverse events from drugs, and assess the budget impact over 5 years.

Materials and Methods: Cost-utility was assessed using a Markov model. Cycle length was set at 1 year and followed a lifetime horizon and societal perspective. The drug treatment to prevent osteoporotic fracture consisted of 4 alternatives: oral bisphosphonates, raloxifene, strontium ranelate, and denosumab for 5 years, compared with no treatment. The willingness to pay threshold was set at 160,000 Thai baht (THB) per quality-adjusted life year (QALY).

Results: Oral bisphosphonates was the only one cost-effective from the age of 65 years with a BMD T-score less than or equal –2.5. The incremental cost-effectiveness ratio (ICER) was 130,049 THB per QALY. The budget impact 15,964 million THB per annum if treated in target population about 1.43 million people per annum.

Conclusion: Bisphosphonates is cost-effective for osteoporotic fracture prevention in postmenopausal women without fracture history but have an enormous budget impact. Negotiated drug prices and clinical risk factors should be considered for the Subcommittee, Development of the National List of Essential Medicines (NLEM).