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Primary prevention of osteoporosis: mass screening scenario or prescreening with questionnaires? An economic perspective.
J Bone Miner Res. 2004 Dec; 19(12):1955-60.JB

Abstract

This study focuses on the controversy surrounding selective approaches to screen for osteoporosis. Seven screening approaches were compared in terms of cost-effectiveness and incremental cost-effectiveness ratios in a sample of 4035 postmenopausal women. Our results show that certain prescreening strategies are more efficient than DXA-based approaches. These results are of considerable value for health policy decision-makers and the scientific community.

INTRODUCTION

There is no general consensus on the most efficient strategy to use bone densitometry for osteoporosis screening. Two distinct approaches have progressively emerged: mass screening using DXA and prescreening strategies using user-friendly risk indices. This study was designed to compare the efficiency of these approaches.

MATERIALS AND METHODS

A database of 4035 medical records from postmenopausal women above 45 years was analyzed. In the first scenario, women were systematically referred to DXA if above 45, 50, or 65 years of age. The second scenario involved the validated prescreening tools SCORE, ORAI, OST, and OSIRIS and assessed two separate ways of handling their results (theoretical and pragmatic). The cost of a DXA test was set as the median Belgian value: 40.14 Euros. All strategies were compared in terms of cost exposed per osteoporotic patient detected and in terms of incremental cost-effectiveness ratios.

RESULTS

In the systematic DXA strategies, the cost per patient detected ranged from 123 Euros when measuring all women >45 years of age to 91 Euros when focusing on women >65 years of age. The corresponding percentage of cases detected ranged from 100% (age > 45 years) to 50% (age > 65 years). When considering prescreening under the theoretical and pragmatic scenarios, the OSIRIS index provided the best efficiency, with costs of 74 Euros (theoretical) to 85 Euros (pragmatic) per case detected, followed by ORAI (75 Euros and 96 Euros), OST (84 Euros and 94 Euros), and SCORE (96 Euros and 103 Euros). The corresponding percentage of cases detected ranged from 89% (SCORE) to 75% (OSIRIS). The cost-effectiveness analysis showed that mass screening strategies over 50 and 65 years of age and using ORAI were best.

CONCLUSIONS

Our study sets the grounds for considering, in a health economics perspective, prescreening tools as valuable, cost-effective, approaches to significantly reduce the economic burden of osteoporosis screening.

Authors+Show Affiliations

University of Liège, Faculty of Science, Department of Public Health, Epidemiology and Health Economics, CHU B23 Sart-Tilman B-4000, Belgium. florent.richy@ulg.ac.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15537437

Citation

Richy, Florent, et al. "Primary Prevention of Osteoporosis: Mass Screening Scenario or Prescreening With Questionnaires? an Economic Perspective." Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, vol. 19, no. 12, 2004, pp. 1955-60.
Richy F, Ethgen O, Bruyere O, et al. Primary prevention of osteoporosis: mass screening scenario or prescreening with questionnaires? An economic perspective. J Bone Miner Res. 2004;19(12):1955-60.
Richy, F., Ethgen, O., Bruyere, O., Mawet, A., & Reginster, J. Y. (2004). Primary prevention of osteoporosis: mass screening scenario or prescreening with questionnaires? An economic perspective. Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research, 19(12), 1955-60.
Richy F, et al. Primary Prevention of Osteoporosis: Mass Screening Scenario or Prescreening With Questionnaires? an Economic Perspective. J Bone Miner Res. 2004;19(12):1955-60. PubMed PMID: 15537437.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary prevention of osteoporosis: mass screening scenario or prescreening with questionnaires? An economic perspective. AU - Richy,Florent, AU - Ethgen,Olivier, AU - Bruyere,Olivier, AU - Mawet,Audrey, AU - Reginster,Jean-Yves, Y1 - 2004/09/20/ PY - 2004/01/13/received PY - 2004/06/22/revised PY - 2004/07/09/accepted PY - 2004/11/13/pubmed PY - 2005/5/6/medline PY - 2004/11/13/entrez SP - 1955 EP - 60 JF - Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research JO - J Bone Miner Res VL - 19 IS - 12 N2 - UNLABELLED: This study focuses on the controversy surrounding selective approaches to screen for osteoporosis. Seven screening approaches were compared in terms of cost-effectiveness and incremental cost-effectiveness ratios in a sample of 4035 postmenopausal women. Our results show that certain prescreening strategies are more efficient than DXA-based approaches. These results are of considerable value for health policy decision-makers and the scientific community. INTRODUCTION: There is no general consensus on the most efficient strategy to use bone densitometry for osteoporosis screening. Two distinct approaches have progressively emerged: mass screening using DXA and prescreening strategies using user-friendly risk indices. This study was designed to compare the efficiency of these approaches. MATERIALS AND METHODS: A database of 4035 medical records from postmenopausal women above 45 years was analyzed. In the first scenario, women were systematically referred to DXA if above 45, 50, or 65 years of age. The second scenario involved the validated prescreening tools SCORE, ORAI, OST, and OSIRIS and assessed two separate ways of handling their results (theoretical and pragmatic). The cost of a DXA test was set as the median Belgian value: 40.14 Euros. All strategies were compared in terms of cost exposed per osteoporotic patient detected and in terms of incremental cost-effectiveness ratios. RESULTS: In the systematic DXA strategies, the cost per patient detected ranged from 123 Euros when measuring all women >45 years of age to 91 Euros when focusing on women >65 years of age. The corresponding percentage of cases detected ranged from 100% (age > 45 years) to 50% (age > 65 years). When considering prescreening under the theoretical and pragmatic scenarios, the OSIRIS index provided the best efficiency, with costs of 74 Euros (theoretical) to 85 Euros (pragmatic) per case detected, followed by ORAI (75 Euros and 96 Euros), OST (84 Euros and 94 Euros), and SCORE (96 Euros and 103 Euros). The corresponding percentage of cases detected ranged from 89% (SCORE) to 75% (OSIRIS). The cost-effectiveness analysis showed that mass screening strategies over 50 and 65 years of age and using ORAI were best. CONCLUSIONS: Our study sets the grounds for considering, in a health economics perspective, prescreening tools as valuable, cost-effective, approaches to significantly reduce the economic burden of osteoporosis screening. SN - 0884-0431 UR - https://www.unboundmedicine.com/medline/citation/15537437/Primary_prevention_of_osteoporosis:_mass_screening_scenario_or_prescreening_with_questionnaires_An_economic_perspective_ L2 - https://doi.org/10.1359/JBMR.040903 DB - PRIME DP - Unbound Medicine ER -