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Using the osteoporosis self-assessment tool for referring older men for bone densitometry: a decision analysis.
J Am Geriatr Soc. 2009 Feb; 57(2):218-24.JA

Abstract

OBJECTIVES

To compare health benefits and costs associated with performing bone densitometry for all men with those of risk-stratifying using the Osteoporosis Self-Assessment Tool (OST) and performing bone densitometry only for a high-risk group.

DESIGN

A decision analytical model was developed using a Markov process. Three strategies were compared: no bone densitometry, selective bone densitometry using the OST, and universal bone densitometry. Data sources were U.S. epidemiological studies and healthcare cost figures.

SETTING

Hypothetical cohort.

PARTICIPANTS

Community-dwelling 70-year-old U.S. white men with no history of clinical osteoporotic fractures.

INTERVENTION

Five years of alendronate therapy for those diagnosed with osteoporosis.

MEASUREMENTS

Life years, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios.

RESULTS

Selective bone densitometry using the OST would cost $100,700 per additional life year gained compared to the no bone densitometry strategy. Universal bone densitometry would cost $483,500 for additional life year gained compared to selective bone densitometry. When quality of life was considered, both strategies became approximately 15% more cost-effective. Compared with the no bone densitometry strategy, selective bone densitometry would be cost saving for those aged 84 and older, with a reduction of alendronate price (< or =$110 per year), or with a higher efficacy of alendronate (a relative risk reduction of nonvertebral fracture > or =82%).

CONCLUSION

Universal bone densitometry for 70-year-old men is not a good investment for society. It is reasonably cost-effective to risk-stratify with the OST, perform bone densitometry only for high-risk group, and then give men diagnosed with osteoporosis generic alendronate.

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Authors+Show Affiliations

Ito K
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. itok1@mskcc.org
Hollenberg JP
No affiliation info available
Charlson ME
No affiliation info available

MeSH

AgedAged, 80 and overAlendronateBone and BonesCost-Benefit AnalysisDensitometryHumansMaleMarkov ChainsOsteoporosisSelf-AssessmentSensitivity and Specificity

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

19207137

Citation

Ito, Kouta, et al. "Using the Osteoporosis Self-assessment Tool for Referring Older Men for Bone Densitometry: a Decision Analysis." Journal of the American Geriatrics Society, vol. 57, no. 2, 2009, pp. 218-24.
Ito K, Hollenberg JP, Charlson ME. Using the osteoporosis self-assessment tool for referring older men for bone densitometry: a decision analysis. J Am Geriatr Soc. 2009;57(2):218-24.
Ito, K., Hollenberg, J. P., & Charlson, M. E. (2009). Using the osteoporosis self-assessment tool for referring older men for bone densitometry: a decision analysis. Journal of the American Geriatrics Society, 57(2), 218-24. https://doi.org/10.1111/j.1532-5415.2008.02110.x
Ito K, Hollenberg JP, Charlson ME. Using the Osteoporosis Self-assessment Tool for Referring Older Men for Bone Densitometry: a Decision Analysis. J Am Geriatr Soc. 2009;57(2):218-24. PubMed PMID: 19207137.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Using the osteoporosis self-assessment tool for referring older men for bone densitometry: a decision analysis. AU - Ito,Kouta, AU - Hollenberg,James P, AU - Charlson,Mary E, PY - 2009/2/12/entrez PY - 2009/2/12/pubmed PY - 2009/3/3/medline SP - 218 EP - 24 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 57 IS - 2 N2 - OBJECTIVES: To compare health benefits and costs associated with performing bone densitometry for all men with those of risk-stratifying using the Osteoporosis Self-Assessment Tool (OST) and performing bone densitometry only for a high-risk group. DESIGN: A decision analytical model was developed using a Markov process. Three strategies were compared: no bone densitometry, selective bone densitometry using the OST, and universal bone densitometry. Data sources were U.S. epidemiological studies and healthcare cost figures. SETTING: Hypothetical cohort. PARTICIPANTS: Community-dwelling 70-year-old U.S. white men with no history of clinical osteoporotic fractures. INTERVENTION: Five years of alendronate therapy for those diagnosed with osteoporosis. MEASUREMENTS: Life years, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios. RESULTS: Selective bone densitometry using the OST would cost $100,700 per additional life year gained compared to the no bone densitometry strategy. Universal bone densitometry would cost $483,500 for additional life year gained compared to selective bone densitometry. When quality of life was considered, both strategies became approximately 15% more cost-effective. Compared with the no bone densitometry strategy, selective bone densitometry would be cost saving for those aged 84 and older, with a reduction of alendronate price (< or =$110 per year), or with a higher efficacy of alendronate (a relative risk reduction of nonvertebral fracture > or =82%). CONCLUSION: Universal bone densitometry for 70-year-old men is not a good investment for society. It is reasonably cost-effective to risk-stratify with the OST, perform bone densitometry only for high-risk group, and then give men diagnosed with osteoporosis generic alendronate. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/19207137/Using_the_osteoporosis_self_assessment_tool_for_referring_older_men_for_bone_densitometry:_a_decision_analysis_ L2 - https://doi.org/10.1111/j.1532-5415.2008.02110.x DB - PRIME DP - Unbound Medicine ER -