Primary Prevention of Osteoporosis: Mass Screening Scenario or Prescreening With Questionnaires? An Economic Perspective
Open Access
- 1 December 2004
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of Bone and Mineral Research
- Vol. 19 (12), 1955-1960
- https://doi.org/10.1359/jbmr.040903
Abstract
This study focuses on the controversy surrounding selective approaches to screen for osteoporosis. Seven screening approaches were compared in terms of cost-effectiveness and incremental cost-effectiveness ratios in a sample of 4035 postmenopausal women. Our results show that certain prescreening strategies are more efficient than DXA-based approaches. These results are of considerable value for health policy decision-makers and the scientific community. Introduction: There is no general consensus on the most efficient strategy to use bone densitometry for osteoporosis screening. Two distinct approaches have progressively emerged: mass screening using DXA and prescreening strategies using user-friendly risk indices. This study was designed to compare the efficiency of these approaches. Materials and Methods: A database of 4035 medical records from postmenopausal women above 45 years was analyzed. In the first scenario, women were systematically referred to DXA if above 45, 50, or 65 years of age. The second scenario involved the validated prescreening tools SCORE, ORAI, OST, and OSIRIS and assessed two separate ways of handling their results (theoretical and pragmatic). The cost of a DXA test was set as the median Belgian value: 40.14£. All strategies were compared in terms of cost exposed per osteoporotic patient detected and in terms of incremental cost-effectiveness ratios. Results: In the systematic DXA strategies, the cost per patient detected ranged from 123£ when measuring all women >45 years of age to 91£ when focusing on women >65 years of age. The corresponding percentage of cases detected ranged from 100% (age > 45 years) to 50% (age > 65 years). When considering prescreening under the theoretical and pragmatic scenarios, the OSIRIS index provided the best efficiency, with costs of 74£ (theoretical) to 85£ (pragmatic) per case detected, followed by ORAI (75£ and 96£), OST (84£ and 94£), and SCORE (96£ and 103£). The corresponding percentage of cases detected ranged from 89% (SCORE) to 75% (OSIRIS). The cost-effectiveness analysis showed that mass screening strategies over 50 and 65 years of age and using ORAI were best. Conclusions: Our study sets the grounds for considering, in a health economics perspective, prescreening tools as valuable, cost-effective, approaches to significantly reduce the economic burden of osteoporosis screening.Keywords
This publication has 17 references indexed in Scilit:
- Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometryGynecological Endocrinology, 2002
- Interest of a Prescreening Questionnaire to Reduce the Cost of Bone DensitometryOsteoporosis International, 2002
- Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometryGynecological Endocrinology, 2002
- Ten Year Probabilities of Osteoporotic Fractures According to BMD and Diagnostic ThresholdsOsteoporosis International, 2001
- Prediction of fracture from low bone mineral density measurements overestimates riskBone, 2000
- A Decision Tree for the Use of Estrogen Replacement Therapy or Hormone Replacement Therapy in Postmenopausal WomenMenopause, 2000
- Interim Report and Recommendations of the World Health Organization Task-Force for OsteoporosisOsteoporosis International, 1999
- Evaluation of the Simple Calculated Osteoporosis Risk Estimation (SCORE) in Older Caucasian Women: The Rancho Bernardo StudyOsteoporosis International, 1999
- Bone mineral density of the spine and the hip measured with dual energy X-ray absorptiometry: Normal range and fracture threshold for Western European (Belgian) postmenopausal femalesClinical Rheumatology, 1995
- The Effect of Postmenopausal Estrogen Therapy on Bone Density in Elderly WomenNew England Journal of Medicine, 1993