Cost-effectiveness of using clinical risk factors with and without DXA for osteoporosis screening in postmenopausal women.
BACKGROUND
According to several guidelines, the assessment of postmenopausal fracture risk should be based on clinical risk factors (CRFs) and bone density. Because measurement of bone density by dual x-ray absorptiometry (DXA) is quite expensive, there has been increasing interest to estimate fracture risk by CRFs.


OBJECTIVE
The aim of this study was to determine the cost-effectiveness of osteoporosis screening of CRFs with and without DXA compared with no screening in postmenopausal women in Germany.


METHODS
A cost-utility analysis and a budget-impact analysis were performed from the perspective of the statutory health insurance. A Markov model simulated costs and benefits discounted at 3% over lifetime.


RESULTS
Cost-effectiveness of CRFs compared with no screening is euro4607, euro21,181, and euro10,171 per quality-adjusted life-year (QALY) for 60-, 70-, and 80-year-old women, respectively. Cost-effectiveness of DXA plus CRFs compared with CRFs alone is euro20,235 for 60-year-old women. In women above the age of 70, DXA plus CRFs dominates CRFs alone. DXA plus CRFs results in annual costs of euro175 million, or 0.4% of the statutory health insurance's annual budget.


CONCLUSIONS
Funders should be careful in adopting a strategy based on CRFs alone instead of DXA plus CRFs. Only if DXA is not available, assessing CRFs only is an acceptable option in predicting a woman's risk of fracture.
Mueller
Dirk
D
Department of Health Economics and Health Care Management, University of Cologne, Cologne, Germany. dirkwmueller@gmx.de
Gandjour
Afschin
A
D015502:Absorptiometry, Photon / Q000191:economics*; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000191:economics / Q000627:therapeutic use; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D017698:Postmenopause; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016387:Women's Health
D050071:Bone Density Conservation Agents; D019386:Alendronate