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Ann Intern Med. 2011 Dec 6;155(11):751-61. doi: 10.7326/0003-4819-155-11-201112060-00007.

Cost-effectiveness of different screening strategies for osteoporosis in postmenopausal women.

Author information

  • 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. nayaks@upmc.edu

Abstract

BACKGROUND:

The best strategies to screen postmenopausal women for osteoporosis are not clear.

OBJECTIVE:

To identify the cost-effectiveness of various screening strategies.

DESIGN:

Individual-level state-transition cost-effectiveness model.

DATA SOURCES:

Published literature.

TARGET POPULATION:

U.S. women aged 55 years or older.

TIME HORIZON:

Lifetime.

PERSPECTIVE:

Payer.

INTERVENTION:

Screening strategies composed of alternative tests (central dual-energy x-ray absorptiometry [DXA], calcaneal quantitative ultrasonography [QUS], and the Simple Calculated Osteoporosis Risk Estimation [SCORE] tool) initiation ages, treatment thresholds, and rescreening intervals. Oral bisphosphonate treatment was assumed, with a base-case adherence rate of 50% and a 5-year on/off treatment pattern.

OUTCOME MEASURES:

Incremental cost-effectiveness ratios (2010 U.S. dollars per quality-adjusted life-year [QALY] gained).

RESULTS OF BASE-CASE ANALYSIS:

At all evaluated ages, screening was superior to not screening. In general, quality-adjusted life-days gained with screening tended to increase with age. At all initiation ages, the best strategy with an incremental cost-effectiveness ratio (ICER) of less than $50,000 per QALY was DXA screening with a T-score threshold of -2.5 or less for treatment and with follow-up screening every 5 years. Across screening initiation ages, the best strategy with an ICER less than $50,000 per QALY was initiation of screening at age 55 years by using DXA -2.5 with rescreening every 5 years. The best strategy with an ICER less than $100,000 per QALY was initiation of screening at age 55 years by using DXA with a T-score threshold of -2.0 or less for treatment and then rescreening every 10 years. No other strategy that involved treatment of women with osteopenia had an ICER less than $100,000 per QALY. Many other strategies, including strategies with SCORE or QUS prescreening, were also cost-effective, and in general the differences in effectiveness and costs between evaluated strategies was small.

RESULTS OF SENSITIVITY ANALYSIS:

Probabilistic sensitivity analysis did not reveal a consistently superior strategy.

LIMITATIONS:

Data were primarily from white women. Screening initiation at ages younger than 55 years were not examined. Only osteoporotic fractures of the hip, vertebrae, and wrist were modeled.

CONCLUSION:

Many strategies for postmenopausal osteoporosis screening are effective and cost-effective, including strategies involving screening initiation at age 55 years. No strategy substantially outperforms another.

PRIMARY FUNDING SOURCE:

National Center for Research Resources.

PMID:
22147714
[PubMed - indexed for MEDLINE]
PMCID:
PMC3318923
Free PMC Article
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