Academic journal article Applied Health Economics and Health Policy

Cost Effectiveness of Ultrasound and Bone Densitometry for Osteoporosis Screening in Post-Menopausal Women

Academic journal article Applied Health Economics and Health Policy

Cost Effectiveness of Ultrasound and Bone Densitometry for Osteoporosis Screening in Post-Menopausal Women

Article excerpt

Abstract Background: According to a new German guideline, decisions about bisphosphonate treatment for post-menopausal women should be based on 10-year fracture risk, and bone density should be measured by dual x-ray absorptiometry (DXA). Recently, there has been growing interest in quantitative ultrasound (QUS) as a less expensive screening alternative.

Objective: To determine the cost effectiveness of osteoporosis screening with QUS as a pre-test for DXA and treatment with alendronate compared with (i) immediate access to DXA and (ii) no screening in women of the general population aged 50-90 years in Germany.

Methods: A cost-utility analysis and a budget impact analysis were performed from the perspective of the statutory health insurance (SHI). A Markov model with a 1-year cycle length was used to simulate costs and benefits (QALYs), discounted at 3% per annum, over a lifetime. The number of women correctly diagnosed by QUS and DXA as being above a 10-year risk of ≥30% was estimated for different age groups (50-60, 60-70, 70-80 and 80-90 years, respectively). The robustness of the results was tested by a probabilistic Monte Carlo simulation.

Results: Compared with no screening, the cost effectiveness of QUS plus DXA was found to be euro3529, euro9983, euro4382 and euro1987 per QALY for 50-, 60-, 70- and 80-year-old women, respectively (year 2006 values). This screening strategy results in annual costs of euro96 million or 0.07% of the SHI's annual budget. The cost effectiveness of DXA alone compared with DXA plus QUS is euro5331, euro60 804, euro14943 and euro3654 per QALY for 50-, 60-, 70- and 80-year-old women, respectively. DXA alone results in a higher number of QALYs in all age groups. The results were robust in the sensitivity analysis.

Conclusion: Compared with no screening, the cost effectiveness of QUS and DXA in sequence is very favourable in all age groups. However, direct access to DXA is also a cost-effective option, as it increases the number of QALYs at an acceptable cost compared with pre-testing by QUS (except for women aged 60-70 years). Therefore, QUS as a pre-test for DXA can be clearly recommended only in women aged 60-70 years. For the other age groups, the cost effectiveness of QUS as a pre-test depends on the global budget constraint and the accessibility of DXA.

Background and Objective

Osteoporosis, a multifactorial disorder resulting in increased bone fragility, occurs in women after menopause and is one of the most important disorders affecting the elderly.[1] Osteoporosis-related fractures, mostly sited at the spine, hip and forearm, typically occur among postmenopausal women.[2] Although medical treatment decreases fracture risk, most affected women are undiagnosed and untreated. In Germany in 2003, only 24% of osteoporotic women received treatment with anti-osteoporotic drugs.[2] Population aging is expected to increase the number of osteoporotic fractures such as hip fractures[3] and, hence, the economic burden for the statutory health insurance (SHI).

Bone mineral density (BMD) is considered an important predictive factor for osteoporotic fractures and is measured by densitometry. Densitometry results are usually reported as a T-score, which is the number of standard deviations between the value of an individual and the mean value of a group of young adults of the same sex[4] According to the criteria of the WHO, osteoporosis is defined by a T-score of -2.5 or less[5]

In Germany, the recommended method for measuring BMD is dual x-ray absorptiometry (DXA) at the lumbar spine or proximal femur.[6] While most guidelines suggest that treatment should be offered on the basis of the results of DXA,[6-8] the costs of DXA are high and availability is limited. In addition, DXA leaves approximately two-thirds of individuals at risk undetected due to insufficient sensitivity (34%).[9] This calls for a more efficient procedure to select women at risk. …

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