PharmacoEconomics & Outcomes News 645 - 21 Jan 2012 Postmenopausal osteoporosis screening: which test is best? Screening postmenopausal women for osteoporosis appears superior to no screening, with QALY gains increasing with age, according to the results of a study published in the Annals of Internal Medicine.1 Specifically, the best strategy appears to be dual-energy X-ray absorptiometry (DXA) screening with a T-score threshold of –2.5 or less for treatment and follow-up screening every 5 years The US-based researchers developed an individuallevel state-transition model to compare nine osteoporosis screening strategies for women aged 55 years or older using DXA, calcaneal quantitative ultrasonography (QUS), and the Simple Calculated Osteoporosis Risk Estimation (SCORE) tool, initiated at a range of ages, treatment thresholds and re-screening intervals. The lifetime costs (in 2010 values) and QALYs were calculated from a payer perspective. Regardless of initiation age, the best strategy that yielded an ICER* of $US50 000 per QALY or less, was DXA screening with a T-score threshold of –2.5 or less for treatment and follow-up screening every 5 years. In taking initiation age into account, the best strategy was screening initiation at 55 years using DXA, a T-score of –2.5 and re-screening every 5 years. When using an ICER of $100 000 per QALY, the best strategy was initiation at 55 years of age using DXA, a T-score of –2.0 and re-screening every 10 years; however, no other strategy that treated women with osteopenia yielded an ICER under $100 000 per QALY. Overall, the differences in effectiveness and costs between the various strategies were small, and many strategies that used QUS or SCORE measures were also cost effective, note the researchers.
Universal screening for over 65s, certainly In an accompanying editorial, Dr John Schousboe of Park Nicollet Health Services and the University of Minnesota and Dr Margaret Gourlay of the University of North Carolina say the study’s findings suggest that universal screening is highly cost effective among older women, and that treatment of osteopenia is not cost effective are consistent with other studies.2 Although the results of the present study suggest screening is cost effective in women aged 55–64 years, Schousboe and Gourlay point out that the model’s estimates for hip and wrist fracture appear to be too high. Despite this, their analysis is "valuable", say Schousboe and Gourlay, and the results clearly show the "strong cost effectiveness of universal bone densitometry for women aged 65 years or older who have not been tested for osteoporosis". * incremental cost-effectiveness ratio 1. Nayak S, et al. Cost-effectiveness of different screening strategies for osteoporosis in postmenopausal women. Annals of Internal Medicine 155: 751-61, No. 11, 6 Dec 2011. Available from: URL: http:// dx.doi.org/10.1059/0003-4819-155-11-201112060-00007. 2. Schousboe JT, et al. Comparative effectiveness and cost-effectiveness of strategies to screen for osteoporosis in postmenopausal women. Annals of Internal Medicine 155: 788-9, No. 11, 6 Dec 2011. Available from: URL: http:// dx.doi.org/10.1059/0003-4819-155-11-201112060-00012. 801130797
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PharmacoEconomics & Outcomes News 21 Jan 2012 No. 645
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