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Cost-effectiveness of vertebral fracture assessment to detect prevalent vertebral deformity and select postmenopausal women with a femoral neck T-score>-2.5 for alendronate therapy: a modeling study.
J Clin Densitom. 2006 Apr-Jun; 9(2):133-43.JC

Abstract

Most fractures occur in postmenopausal women who do not have osteoporosis by bone density criteria (T-score>-2.5). Prevalent vertebral deformity is a strong risk factor for incident fractures independent of bone mineral density, yet the majority of these deformities are clinically unapparent. Spine imaging on a dual-energy densitometer, called vertebral fracture assessment (VFA), can accurately detect these deformities. The purpose of this modeling study was to estimate the lifetime societal costs and health benefits of VFA and confirmatory follow-up radiography to detect prevalent vertebral deformity in osteopenic (T-score -1.5, -2.0, or -2.4) postmenopausal women, followed by anti-resorptive drug therapy for those with one or more deformities. We compared three strategies; no initial drug therapy, 5 yr of initial alendronate therapy, or VFA followed by 5 yr of alendronate therapy in those with one or more vertebral deformities confirmed on radiography (VFA strategy). Results for the base-case analyses showed that the cost per quality adjusted life year (QALY) gained for the VFA strategy relative to no initial drug therapy ranged from 18,000 US dollars (for a 60-yr-old with a femoral neck T-score of -2.4) to 77,000 US dollars (for an 80-yr-old with a T-score of -1.5). VFA with selective confirmatory radiography is cost-effective, assuming a societal willingness to pay per QALY gained of 50,000 US dollars, for postmenopausal women aged 60 to 80 yr with femoral neck T-scores between -2.0 and -2.4, and for women age 60 or 70 yr with a T-score of -1.5. Assuming a societal willingness to pay of 100,000 US dollars per QALY gained, VFA is also cost-effective for women age 80 yr with a T-score of -1.5. These conclusions are robust to reasonable changes in fracture rates, assumed fracture disutility, discount rates, relative risk of fracture attributable to vertebral deformity, alendronate cost, and drug adherence.

Authors+Show Affiliations

Park Nicollet Health Services, Minneapolis, MN 55416, USA. schouj@parknicollet.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16785071

Citation

Schousboe, John T., et al. "Cost-effectiveness of Vertebral Fracture Assessment to Detect Prevalent Vertebral Deformity and Select Postmenopausal Women With a Femoral Neck T-score>-2.5 for Alendronate Therapy: a Modeling Study." Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry, vol. 9, no. 2, 2006, pp. 133-43.
Schousboe JT, Ensrud KE, Nyman JA, et al. Cost-effectiveness of vertebral fracture assessment to detect prevalent vertebral deformity and select postmenopausal women with a femoral neck T-score>-2.5 for alendronate therapy: a modeling study. J Clin Densitom. 2006;9(2):133-43.
Schousboe, J. T., Ensrud, K. E., Nyman, J. A., Kane, R. L., & Melton, L. J. (2006). Cost-effectiveness of vertebral fracture assessment to detect prevalent vertebral deformity and select postmenopausal women with a femoral neck T-score>-2.5 for alendronate therapy: a modeling study. Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry, 9(2), 133-43.
Schousboe JT, et al. Cost-effectiveness of Vertebral Fracture Assessment to Detect Prevalent Vertebral Deformity and Select Postmenopausal Women With a Femoral Neck T-score>-2.5 for Alendronate Therapy: a Modeling Study. J Clin Densitom. 2006 Apr-Jun;9(2):133-43. PubMed PMID: 16785071.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of vertebral fracture assessment to detect prevalent vertebral deformity and select postmenopausal women with a femoral neck T-score>-2.5 for alendronate therapy: a modeling study. AU - Schousboe,John T, AU - Ensrud,Kristine E, AU - Nyman,John A, AU - Kane,Robert L, AU - Melton,L Joseph,3rd Y1 - 2006/04/18/ PY - 2005/09/04/received PY - 2005/10/07/revised PY - 2005/11/01/accepted PY - 2006/6/21/pubmed PY - 2006/9/20/medline PY - 2006/6/21/entrez SP - 133 EP - 43 JF - Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry JO - J Clin Densitom VL - 9 IS - 2 N2 - Most fractures occur in postmenopausal women who do not have osteoporosis by bone density criteria (T-score>-2.5). Prevalent vertebral deformity is a strong risk factor for incident fractures independent of bone mineral density, yet the majority of these deformities are clinically unapparent. Spine imaging on a dual-energy densitometer, called vertebral fracture assessment (VFA), can accurately detect these deformities. The purpose of this modeling study was to estimate the lifetime societal costs and health benefits of VFA and confirmatory follow-up radiography to detect prevalent vertebral deformity in osteopenic (T-score -1.5, -2.0, or -2.4) postmenopausal women, followed by anti-resorptive drug therapy for those with one or more deformities. We compared three strategies; no initial drug therapy, 5 yr of initial alendronate therapy, or VFA followed by 5 yr of alendronate therapy in those with one or more vertebral deformities confirmed on radiography (VFA strategy). Results for the base-case analyses showed that the cost per quality adjusted life year (QALY) gained for the VFA strategy relative to no initial drug therapy ranged from 18,000 US dollars (for a 60-yr-old with a femoral neck T-score of -2.4) to 77,000 US dollars (for an 80-yr-old with a T-score of -1.5). VFA with selective confirmatory radiography is cost-effective, assuming a societal willingness to pay per QALY gained of 50,000 US dollars, for postmenopausal women aged 60 to 80 yr with femoral neck T-scores between -2.0 and -2.4, and for women age 60 or 70 yr with a T-score of -1.5. Assuming a societal willingness to pay of 100,000 US dollars per QALY gained, VFA is also cost-effective for women age 80 yr with a T-score of -1.5. These conclusions are robust to reasonable changes in fracture rates, assumed fracture disutility, discount rates, relative risk of fracture attributable to vertebral deformity, alendronate cost, and drug adherence. SN - 1094-6950 UR - https://www.unboundmedicine.com/medline/citation/16785071/Cost_effectiveness_of_vertebral_fracture_assessment_to_detect_prevalent_vertebral_deformity_and_select_postmenopausal_women_with_a_femoral_neck_T_score>_2_5_for_alendronate_therapy:_a_modeling_study_ DB - PRIME DP - Unbound Medicine ER -