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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.

Authors+Show Affiliations

Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. itok1@mskcc.orgNo affiliation info availableNo affiliation info available

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 -