title: Cost-effectiveness of fracture prevention in rural women with limited access to dual-energy X-ray absorptiometry.
abstract: A reduced reimbursement for office-based dual-energy X-ray absorptiometry (DXA) is likely to exacerbate the burden of fractures in rural areas. Our cost-effective analysis suggests that, in areas where access to DXA is limited, treatment for women at high clinical risk for fractures could both improve health and save money.
  
  
  BACKGROUND
  To evaluate the cost-effectiveness of various fracture prevention strategies for rural women with limited access to dual-energy X-ray absorptiometry (DXA).
  
  
  METHODS
  A Markov model was developed using data from the published literature and the Manitoba Bone Density Program. The participants were a simulated cohort of rural women aged 65 years with travel distance between 10 and 24 mi to the nearest DXA site. The evaluated strategies were (1) watchful waiting, (2) bone mineral density (BMD)-based strategy (i.e., DXA screening followed by pharmacotherapy based on BMD), and (3) clinical risk factor (CRF)-based strategy (i.e., pharmacotherapy for women at high risk for fractures by the World Health Organization Fracture Risk Assessment Tool [FRAX]). The outcome was an incremental cost-effectiveness ratio (ICER) measured by cost per quality-adjusted life-year (QALY) gained. The analysis was preformed from a societal perspective over a lifetime horizon.
  
  
  RESULTS
  In the base-case analysis, the BMD-based strategy had an ICER of $6000 per QALY gained. For those with travel distance between 25 and 39 mi, the BMD-based strategy would have an ICER of $140,800 per QALY gained. For those with travel distance greater than 40 mi, the CRF-based strategy would be more effective and less costly than other strategies.
  
  
  CONCLUSIONS
  In areas where DXA is readily available, DXA screening followed by pharmacotherapy guided by BMD would be preferred. In areas with more limited access to DXA, pharmacotherapy for women at high clinical risk for fractures based on FRAX could both improve health and save money from the societal perspective.
authors: Division of Geriatric Medicine, Department of Primary Care, University of New England College of Osteopathic Medicine, 11 Hills Beach Road, Biddeford, ME, 04005, USA, kito@une.edu.
authors: K
authors: K
authors: Ito
authors: W D
authors: WD
authors: Leslie
mesh_terms: D015502:Absorptiometry, Photon / Q000706:statistics & numerical data; D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D008350:Manitoba / Q000453:epidemiology; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008507:Medically Underserved Area; D017059:Models, Econometric; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D011788:Quality of Life; D015203:Reproducibility of Results; D019035:Rural Health Services / Q000191:economics*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents