title: Evidence to inform decision makers in Thailand: a cost-effectiveness analysis of screening and treatment strategies for postmenopausal osteoporosis.
abstract: OBJECTIVE
  To assess value for money of providing systematic screening for osteoporosis among postmenopausal women and medical treatments for those diagnosed with osteoporosis as evidence-based decision making for the revision of the National List of Essential Medicines.
  
  
  METHODS
  Decision analytic models were constructed, using a societal perspective, to assess the cost per quality-adjusted life-years (QALYs) gained from systematic screening using the Osteoporosis Self-Assessment Tool and dual-energy X-ray absorptiometry or dual-energy X-ray absorptiometry alone compared with no screening. Alendronate, risedronate, raloxifene, and nasal calcitonin were economically evaluated to determine a treatment of choice for the prevention of osteoporosis-related fractures. Most input parameters were obtained from literature reviews, and systematic reviews and meta-analyses, if available. The service costs and related household expenses were based on the Thai setting. Probabilistic and one-way sensitivity analyses were used to incorporate the impact of parameter uncertainty.
  
  
  RESULTS
  The Osteoporosis Self-Assessment Tool and sequential dual-energy X-ray absorptiometry provided better value for money for osteoporosis screening among young age groups (<60 years old). Although there was no significant difference in cost per QALY for older age groups, alendronate provided the lowest incremental cost-effectiveness ratio while nasal calcitonin presented the highest incremental cost-effectiveness ratio. It was shown that providing medication for a secondary prevention yielded a much higher cost per QALY gained compared with providing medication for a primary prevention.
  
  
  CONCLUSIONS
  Given the benchmark set at 100,000 Thai baht per QALY gained, providing systematic screening and treatment for osteoporosis was cost-ineffective in the Thai setting.
authors.affiliation: Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Nonthaburi, Thailand. pritaporn.k@hitap.net
authors.forename: Pritaporn
authors.initials: P
authors.lastname: Kingkaew
authors.forename: Usawadee
authors.initials: U
authors.lastname: Maleewong
authors.forename: Chardpraorn
authors.initials: C
authors.lastname: Ngarmukos
authors.forename: Yot
authors.initials: Y
authors.lastname: Teerawattananon
mesh_terms: D015502:Absorptiometry, Photon / Q000191:economics; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000191:economics / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000191:economics* / Q000627:therapeutic use*; D002116:Calcitonin / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D012968:Etidronic Acid / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000191:economics / Q000209:etiology; D019057:Quality-Adjusted Life Years; D020849:Raloxifene Hydrochloride / Q000191:economics / Q000627:therapeutic use; D000068296:Risedronic Acid; D011795:Surveys and Questionnaires / Q000191:economics; D013785:Thailand
chemical_list: D050071:Bone Density Conservation Agents; D020849:Raloxifene Hydrochloride; D002116:Calcitonin; D000068296:Risedronic Acid; D012968:Etidronic Acid; D019386:Alendronate