Using the osteoporosis self-assessment tool for referring older men for bone densitometry: a decision analysis.
OBJECTIVE
To compare health benefits and costs associated with performing bone densitometry for all men with those of risk-stratifying using the Osteoporosis Self-Assessment Tool (OST) and performing bone densitometry only for a high-risk group.


METHODS
A decision analytical model was developed using a Markov process. Three strategies were compared: no bone densitometry, selective bone densitometry using the OST, and universal bone densitometry. Data sources were U.S. epidemiological studies and healthcare cost figures.


METHODS
Hypothetical cohort.


METHODS
Community-dwelling 70-year-old U.S. white men with no history of clinical osteoporotic fractures.


METHODS
Five years of alendronate therapy for those diagnosed with osteoporosis.


METHODS
Life years, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios.


RESULTS
Selective bone densitometry using the OST would cost $100,700 per additional life year gained compared to the no bone densitometry strategy. Universal bone densitometry would cost $483,500 for additional life year gained compared to selective bone densitometry. When quality of life was considered, both strategies became approximately 15% more cost-effective. Compared with the no bone densitometry strategy, selective bone densitometry would be cost saving for those aged 84 and older, with a reduction of alendronate price (< or =$110 per year), or with a higher efficacy of alendronate (a relative risk reduction of nonvertebral fracture > or =82%).


CONCLUSIONS
Universal bone densitometry for 70-year-old men is not a good investment for society. It is reasonably cost-effective to risk-stratify with the OST, perform bone densitometry only for high-risk group, and then give men diagnosed with osteoporosis generic alendronate.
Ito
Kouta
K
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. itok1@mskcc.org
Hollenberg
James P
JP
Charlson
Mary E
ME
D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000627:therapeutic use; D001842:Bone and Bones / Q000033:anatomy & histology*; D003362:Cost-Benefit Analysis; D003720:Densitometry / Q000191:economics / Q000379:methods*; D006801:Humans; D008297:Male; D008390:Markov Chains; D010024:Osteoporosis / Q000175:diagnosis* / Q000188:drug therapy; D012647:Self-Assessment; D012680:Sensitivity and Specificity
D019386:Alendronate