title: Techniques for diagnosing osteoporosis: a systematic review of cost-effectiveness studies.
abstract: OBJECTIVE
  The study question was whether dual-energy X-ray absorptiometry (DXA) alone is more cost-effective for identifying postmenopausal women with osteoporosis than a two-step procedure with quantitative ultrasound sonography (QUS) plus DXA. To answer this question, a systematic review was performed.
  
  
  METHODS
  Electronic databases (PubMed, INAHTA, Health Evidence Network, NIHR, the Health Technology Assessment program, the NHS Economic Evaluation Database, Research Papers in Economics, Web of Science, Scopus, and EconLit) were searched for cost-effectiveness publications. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using the Drummond checklist.
  
  
  RESULTS
  Seven journal articles and four reports were reviewed. The cost per true positive case diagnosed by DXA was found to be higher than that for diagnosis by QUS+DXA in two articles. In one article it was found to be lower. In three studies, the results were not conclusive. These articles were characterized by the differences in the types of devices, parameters and thresholds on the QUS and DXA tests and the unit costs of the DXA and QUS tests as well as by variability in the sensitivity and specificity of the techniques and the prevalence of osteoporosis.
  
  
  CONCLUSIONS
  The publications reviewed did not provide clear-cut evidence for drawing conclusions about which screening test may be more cost-effective for identifying postmenopausal women with osteoporosis.
authors.affiliation: Health Service Organization,Turin,Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Minniti
authors.affiliation: Emergency Radiology Division,San Giovanni Battista University Hospital.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Davini
authors.affiliation: Department of Public Health,University of Turin,Italymariarosaria.gualano@unito.it.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Gualano
authors.affiliation: Department of Public Health,University of Turin,Italymariarosaria.gualano@unito.it.
authors.forename: Maria Michela
authors.initials: MM
authors.lastname: Gianino
mesh_terms: D015502:Absorptiometry, Photon / Q000191:economics*; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000191:economics*