Abstract
The aim of our study was to assess, from the perspective of the National Health Services in Spain, the cost-effectiveness of quantitative ultrasound (QUS) as a prescreen referral method for bone mineral density (BMD) assessment by dual-energy X-ray absorptiometry (DXA) in postmenopausal women of the general population. Using femoral neck DXA and heel QUS. We evaluated 267 consecutive postmenopausal women 65 years and older and attending primary care physician offices for any medical reason. Subjects were classified as osteoporotic or nonosteoporotic (normal or osteopenic) using the WHO definition for DXA. Effectiveness was assessed in terms of the sensitivity and specificity of the referral decisions based on the QUS measurement. Local costs were estimated from health services and actual resource used. Cost-effectiveness was evaluated in terms of the expected cost per true positive osteoporotic case detected. Baseline prevalence of osteoporosis evaluated by DXA was 55.8%. The sensitivity and specificity for the diagnosis of osteoporosis by QUS using the optimal cutoff thresholds for the estimated heel BMD T-score were 97% and 94%, respectively. The average cost per osteoporotic case detected based on DXA measurement alone was € 23.85. The average cost per osteoporotic case detected using QUS as a prescreen was €22.00. The incremental cost-effectiveness of DXA versus QUS was €114.00 per true positive case detected. Our results suggest that screening for osteoporosis with QUS while applying strict cufoff values in postmenopausal women of the general population is not substantially more cost-effective than DXA alone for the diagnosis of osteoporosis. However, the screening strategy with QUS may be an option in those circumstances where the diagnosis of osteoporosis is deficient because of the difficulty in accessing DXA equipment.
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References
InstitutionalAuthorNameNIH Consensus Development Panel (2001) ArticleTitleOsteoporosis prevention, diagnosis, and therapy. JAMA 285 785–795 Occurrence Handle11176917
JA Kanis LJ Melton C Christiansen CC Johnston N Khaltaev (1994) ArticleTitleThe diagnosis of Osteoporosis. J Bone Miner Res 9 1114–1137
InstitutionalAuthorNamelInternational Osteoporosis Foundation (IOF) (2001) Osteoporosis in the European Community: a call to action. An audit of policy development since 1998. IOF Brussels
K Lippuner J von Overbeck R Perrelet H Bosshard P Jaeger (1997) ArticleTitleIncidence and direct medical costs of hospitalisation due to osteoporotic fractures in Switzerland. Osteoporos Int 7 414–425 Occurrence Handle1:STN:280:DyaK1c%2Fos1Kgtw%3D%3D Occurrence Handle9425498
InstitutionalAuthorNameRoyal Collegue of Physicians of UK (1999) Guidelines for the prevention and treatment of osteoporosis. Royal Collegue of Physicians of UK London
DM Eddy CC Johnston Jr SR Cummings B Dawson–Hughes R Lindsay LJ Melton III CW Slemenda (1998) ArticleTitleOsteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-effectiveness analysis. Osteoporos Int 8 S7–S80 Occurrence Handle1:CAS:528:DyaK1cXmvFahtLg%3D
SR Cummings D Bates DM Black (2002) ArticleTitleClinical use of bone densitometry. Scientific review. JAMA 288 1889–1897 Occurrence Handle10.1001/jama.288.15.1889 Occurrence Handle12377088
InstitutionalAuthorNameU.S. Preventive Services Task Force (2002) ArticleTitleScreening for Osteoporosis in postmenopausal women: recommendations and rationale. Ann Intern Med 137 526–528
JE Compston C Cooper JA Kanis (1995) ArticleTitleBone densitometry in clinical practice. Br Med J 310 1507–1510 Occurrence Handle1:STN:280:ByqA3cjivVc%3D
R Aragonès P Orozco InstitutionalAuthorNameGrupo de Osteoporosis de la Societat Catalana de Medicina Familiar i Comunitària (2002) ArticleTitleAbordaje de la Osteoporosis en la atención primaria en España (estudio ABOPAP-2000). At Primaria 6 350–356
InstitutionalAuthorNameGluer CC for the International Quantitative Ultrasound Consensus Group (1997) ArticleTitleQuantitative ultrasound techniques for the assessment of osteoporosis: expert agreement on current status. J Bone Miner Res 12 1280–1288 Occurrence Handle9258759
DC Bauer (1999) Clinical applications of quantitative ultrasound. CF Njeh D Hans T Fuerst CC Glüer HK Genant (Eds) Quantitative ultrasound: assessment of Osteoporosis and bone status. Martin Dunitz Ltd London 283
CM Langton PA Ballard DK Langton DW Purdie (1997) ArticleTitleMaximising the cost effectiveness of BMD referral for DXA using ultrasound as a selective population pre-screen. Technol Health Care 5 235–241 Occurrence Handle1:STN:280:ByiH3cfosFc%3D Occurrence Handle9263372
CM Langton DK Langton SA Beardsworth (1999) ArticleTitleComparison of accuracy and cost effectiveness of clinical criteria and BUA for referral for BMD assessment by DXA in Osteoporosis and osteopenic perimenopausal subjects. Technol Health Care 7 319–330 Occurrence Handle1:STN:280:DC%2BD3c%2FgvVOlsA%3D%3D Occurrence Handle10543417
K Lippuner G Fuchs AG Ruetsche R Perrelet JP Casez I Neto (2000) ArticleTitleHow well do radiographic absorptiometry and quantitative ultrasound predict osteoporosis at spine and hip?. A cost-effectiveness analysis. J Clin Densitom 3 241–249 Occurrence Handle1:STN:280:DC%2BD3M%2FovVCnuw%3D%3D Occurrence Handle11090231
A Díez–Pérez F Marín J Vila M Abizanda A Cervera C Carbonell RM Alcolea A Cama T Rama E Galindo C Olmos (2003) ArticleTitleEvaluation of calcaneal quantitative ultrasound in a primary care setting as a screening tool for osteoporosis in postmenopausal women. J Clin Densitom 6 237–245 Occurrence Handle10.1385/JCD:6:3:237 Occurrence Handle14514993
R Jaeschke G Guyatt J Lijmer (2002) Diagnostic tests. G Guyatt D Rennie R Hayward (Eds) User’s Guide to the Medical Literature. A Manual for Evidence-Based Clinical Practice. JAMA & Archives Journals. AMA Press Chicago 187
MF Drummond B O’Brien GL Stoddart GW Torrance (1997) Methods for the Economic Evaluation of Health Care Programmes, 2nd ed. Oxford University Press Oxford
MFV Sim M Stone A Johansen W Evans (2000) ArticleTitleCost-effectiveness analysis of BMD referral for DXA using ultrasound as a selective pre-screening in a group of women with low trauma Colles’ fractures. Technol Health Care 8 277–284 Occurrence Handle1:STN:280:DC%2BD3M7nvVertA%3D%3D Occurrence Handle11204173
PD Miller ES Siris E Barrett–Connor KG Faulkner LE Wehren TA Abbott YT Chen ML Berger AC Santora LM Sherwood (2002) ArticleTitlePrediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 17 2222–2230 Occurrence Handle12469916
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Marín, F., López–Bastida, J., Díez–Pérez, A. et al. Bone Mineral Density Referral for Dual-Energy X-Ray Absorptiometry Using Quantitative Ultrasound as a Prescreening Tool in Postmenopausal Women from the General Population: A Cost-Effectiveness Analysis. Calcif Tissue Int 74, 277–283 (2004). https://doi.org/10.1007/s00223-003-0135-0
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DOI: https://doi.org/10.1007/s00223-003-0135-0