Seville, Spain––Is it cost-effective to screen for osteoporosis using the prescreening Fracture Risk Assessment Tool (FRAX) scores in all women 60 years and older? In a presentation at the 2014 European Society for Clinical and Economic Aspects of Osteoporosis meeting, a group of researchers from Belgium and Holland made the case that it is cost-effective. Using a simulation model of women living in the province of Liège, Belgium, the study investigators calculated that the incremental cost-effectiveness ratio for population-wide screening is €73,050 (approximately $102,000) per quality-adjusted life-year gained.
“This is less than the threshold for acceptable cost-effectiveness in the literature of 2 times the gross domestic product,” lead study investigator Mickaël Hiligsmann, PhD, Assistant Professor of Health Economics and Health Technology Assessment, Department of Health Services Research, Maastricht University, the Netherlands, told Value-Based Care in Rheumatology. He noted, however, that his team was not able to check whether these results hold true in clinical practice because that “would require decades of follow-up to capture the long-term benefits of preventing fractures.”
The team’s model was based on data from 650 Belgian women who were screened for osteoporosis between January 2011 and May 2013 by healthcare personnel working in mobile units. FRAX was assessed in all the women. Bone densitometry was tested in women with a positive FRAX score and treatment with oral bisphosphonates was given for those with T-scores of ≤–2.5. Based on the sample, researchers estimated that prescreening with the FRAX score has a specificity of 86% and a sensitivity of 71%.
Information from administrative health databases in Liège showed that 21.8% of women in the province had a positive FRAX score. Approximately 85% of women with a positive FRAX score had a follow-up bone densitometry and 44.4% of those patients were found to have osteoporosis. Furthermore, 4.9% of women found not to have osteoporosis based on FRAX, had false negatives, and among the 15% of women with a positive FRAX score who did not receive densitometry, 44.4% had osteoporosis. Approximately 13% of those who were not screened, were diagnosed at some point with osteoporosis; this is the same percentage as women who were screened (Hiligsmann M, et al. Rev Med Liege. 2008;63:588-594).
The per-person cost was €3.7 for FRAX assessment (approximately $5.16) and €58 for bone densitometry (approximately $80.45). This included the cost of the mobile screening units and the salary of the healthcare workers involved in the campaign, plus other fixed and variable costs.
The Markov microsimulation model yielded an incremental cost-effectiveness ratio of €73,050 per quality-adjusted life-year gained. In addition, the researchers found that cost effectiveness was even greater when generic was used instead of brand-name bisphosphonates, and when there was 100% adherence to treatment and follow-up. The researchers also determined that the screening strategy remained cost-effective even if there was only 70% follow-up among women with a positive FRAX score, or if the cost of FRAX assessment increased by 50%.
To improve the efficiency of the screening strategy, the study investigators suggest screening women who have 1 or more clinical risk factors or women aged 65 years and older.