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Vertebral fracture assessment (VFA) for osteoporosis screening in US postmenopausal women: is it cost-effective?

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Abstract

Summary

Vertebral fracture assessment (VFA) is cost-effective when it was incorporated in the routine screening for osteoporosis in community-dwelling women aged ≥ 65 years, which support guidelines, such as the National Osteoporosis Foundation (NOF) for the diagnostic use of VFA as an important addition to fracture risk assessment.

Introduction

To evaluate the cost-effectiveness of VFA as a screening tool to reduce future fracture risk in US community–dwelling women aged ≥ 65 years.

Methods

An individual-level state-transition cost-effectiveness model from a healthcare perspective was constructed using derived data from published literature. The time horizon was lifetime. Five screening strategies were compared, including no screening at all, central dual-energy X-ray absorptiometry (DXA) only, VFA only, central DXA followed by VFA if the femoral neck T-score (FN-T) ≤ − 1.5, or if the FN-T ≤ − 1.0. Various initiation ages and rescreening intervals were evaluated. Oral bisphosphonate treatment for 5-year periods was assumed. Incremental cost-effectiveness ratios (2017 US dollars per quality-adjusted life-year (QALY) gained) were used as the outcome measure.

Results

The incorporation of VFA slightly increased life expectancy by 0.1 years and reduced the number of subsequent osteoporotic fractures by 3.7% and 7.7% compared with using DXA alone and no screening, respectively, leading to approximately 30 billion dollars saved. Regardless of initiation ages and rescreening intervals, central DXA followed by VFA if the FN-T ≤ − 1.0 was most cost-effective ($40,792 per QALY when the screening is initiated at age 65 years and with rescreening every 5 years). Results were robust to change in VF incidence and medication costs.

Conclusion

In women aged ≥ 65 years, VFA is cost-effective when it was incorporated in routine screening for osteoporosis. Our findings support the National Osteoporosis Foundation (NOF) guidelines for the diagnostic use of VFA as an important addition to fracture risk assessment.

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Authors and Affiliations

  1. Institute for Social and Economic Research and Policy (ISERP), Columbia University, New York, NY, 10027, USA

    J. Yang

  2. Department of Medicine, Columbia University, New York, NY, 10032, USA

    F. Cosman

  3. School of Nursing, Columbia University, New York, NY, USA

    P.W. Stone

  4. Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA

    M. Li

  5. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA

    J.W. Nieves

  6. Hospital for Special Surgery, New York, NY, 10021, USA

    J.W. Nieves

  7. Department of Epidemiology and Institute of Human Nutrition, Columbia University, 630 West 168th Street, IHN PH 1512, New York, NY, 10032, USA

    J.W. Nieves

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Jingyan Yang was a student of Columbia University at the time this work was conducted and is currently employed by Pfizer Inc. Jeri W. Nieves receives study drug from Eli Lilly and Radius Health. Felicia Cosman consults for, serves as advisor for, and receives lecture fees from Amgen and Radius. She previously received consulting, advising, and speaking fees from Eli Lilly and advisory fees from Merck. She also received grant support from Eli Lilly and Amgen. Patricia W. Stone has no conflicts. Meng Li has no conflicts.

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Yang, J., Cosman, F., Stone, P. et al. Vertebral fracture assessment (VFA) for osteoporosis screening in US postmenopausal women: is it cost-effective?. Osteoporos Int 31, 2321–2335 (2020). https://doi.org/10.1007/s00198-020-05588-6

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  • DOI: https://doi.org/10.1007/s00198-020-05588-6

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