Bazedoxifene is a novel
selective estrogen receptor modulator (
SERM) for the prevention and treatment of
osteoporosis. In addition to the therapeutic value of a new agent, evaluation of the cost-effectiveness compared with relevant alternative treatment(s) is an important consideration to facilitate healthcare decision making. This study evaluated the cost-effectiveness of
bazedoxifene compared with
raloxifene for the treatment of postmenopausal women with
osteoporosis. The cost-effectiveness of treatment for 3 years with
bazedoxifene was compared with
raloxifene using an updated version of a previously validated Markov microsimulation model. Analyses were conducted from a Belgian healthcare payer perspective and, the base-case population was women (aged 70 years) with bone mineral density T-score ≤ -2.5. The effects of
bazedoxifene and
raloxifene on fracture risk were derived from the 3-year results of a randomized, double-blind, placebo-controlled and active-controlled study, including postmenopausal women with
osteoporosis. The cost-effectiveness analysis based on efficacy data from the overall clinical trial indicated that
bazedoxifene and
raloxifene were equally cost-effective. When the results were examined based on the subgroup analysis of women at higher risk of fractures,
bazedoxifene was dominant (lower cost for higher effectiveness) compared with
raloxifene in most of the simulations. Sensitivity analyses confirmed the robustness of the results, which were largely independent of starting age of treatment, fracture risk, cost, and disutility. In addition, when the cost of
raloxifene was reduced by one-half or when incorporating the
raloxifene effects on reducing
breast cancer,
bazedoxifene remained cost-effective, at a threshold of €35,000 per quality-adjusted life-years gained, in 85% and 68% of the simulations, respectively. Under the assumption of improved antifracture efficacy of
bazedoxifene over
raloxifene in women with high risk of fractures, this study suggests that
bazedoxifene can be considered cost-effective, and even dominant, when compared with
raloxifene in the treatment of postmenopausal osteoporotic women.