title: Cost-effectiveness of different screening strategies for osteoporosis in postmenopausal women.
abstract: BACKGROUND
  The best strategies to screen postmenopausal women for osteoporosis are not clear.
  
  
  OBJECTIVE
  To identify the cost-effectiveness of various screening strategies.
  
  
  METHODS
  Individual-level state-transition cost-effectiveness model.
  
  
  METHODS
  Published literature.
  
  
  METHODS
  U.S. women aged 55 years or older.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Payer.
  
  
  METHODS
  Screening strategies composed of alternative tests (central dual-energy x-ray absorptiometry [DXA], calcaneal quantitative ultrasonography [QUS], and the Simple Calculated Osteoporosis Risk Estimation [SCORE] tool) initiation ages, treatment thresholds, and rescreening intervals. Oral bisphosphonate treatment was assumed, with a base-case adherence rate of 50% and a 5-year on/off treatment pattern.
  
  
  METHODS
  Incremental cost-effectiveness ratios (2010 U.S. dollars per quality-adjusted life-year [QALY] gained).
  
  
  RESULTS
  At all evaluated ages, screening was superior to not screening. In general, quality-adjusted life-days gained with screening tended to increase with age. At all initiation ages, the best strategy with an incremental cost-effectiveness ratio (ICER) of less than $50,000 per QALY was DXA screening with a T-score threshold of -2.5 or less for treatment and with follow-up screening every 5 years. Across screening initiation ages, the best strategy with an ICER less than $50,000 per QALY was initiation of screening at age 55 years by using DXA -2.5 with rescreening every 5 years. The best strategy with an ICER less than $100,000 per QALY was initiation of screening at age 55 years by using DXA with a T-score threshold of -2.0 or less for treatment and then rescreening every 10 years. No other strategy that involved treatment of women with osteopenia had an ICER less than $100,000 per QALY. Many other strategies, including strategies with SCORE or QUS prescreening, were also cost-effective, and in general the differences in effectiveness and costs between evaluated strategies was small.
  
  
  RESULTS
  Probabilistic sensitivity analysis did not reveal a consistently superior strategy.
  
  
  CONCLUSIONS
  Data were primarily from white women. Screening initiation at ages younger than 55 years were not examined. Only osteoporotic fractures of the hip, vertebrae, and wrist were modeled.
  
  
  CONCLUSIONS
  Many strategies for postmenopausal osteoporosis screening are effective and cost-effective, including strategies involving screening initiation at age 55 years. No strategy substantially outperforms another.
  
  
  BACKGROUND
  National Center for Research Resources.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. nayaks@upmc.edu
authors.forename: Smita
authors.initials: S
authors.lastname: Nayak
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
authors.forename: Susan L
authors.initials: SL
authors.lastname: Greenspan
mesh_terms: D015502:Absorptiometry, Photon / Q000191:economics; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use; D002111:Calcaneus / Q000000981:diagnostic imaging; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control; D058866:Osteoporotic Fractures / Q000517:prevention & control; D011336:Probability; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000191:economics; D013997:Time Factors; D014463:Ultrasonography / Q000191:economics
chemical_list: D050071:Bone Density Conservation Agents