title: Cost-effectiveness of using clinical risk factors with and without DXA for osteoporosis screening in postmenopausal women.
abstract: 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.
authors.affiliation: Department of Health Economics and Health Care Management, University of Cologne, Cologne, Germany. dirkwmueller@gmx.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Mueller
authors.forename: Afschin
authors.initials: A
authors.lastname: Gandjour
mesh_terms: 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
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate