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Cost-effectiveness of bone densitometry among Caucasian women and men without a prior fracture according to age and body weight.

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22349916
10.1007/s00198-012-1936-7
PMC3739718
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
Jan. 1, 2013
Park Nicollet Institute, Minneapolis, MN, USA. john.schousboe@parknicollet.com
Models, Econometric, Osteoporotic Fractures, Quality-Adjusted Life Years, Health Care Costs, Patient Selection, Male, Body Weight, Risk Assessment, Absorptiometry, Photon, Middle Aged, Cost-Benefit Analysis, Humans, Female, Bone Density, Aged, Age Factors, Osteoporosis, Aged, 80 and over
R01 AG027576, R01 AG027574, UL1 RR024140, U01 AG042140, U01 AR045614, U01 AR045654, U01 AR045583, U01 AR045647, U01 AG027810, U01 AR045580, U01 AG018197, U01 AR066160, U01 AR045632, R01 AR035583, R01 AR035584, R01 AG005407, R01 AR035582, R01 AG005394
Cummings SR, Melton LJ 3rd, Ensrud KE, Orwoll ES, Barrett-Connor E, Fink HA, Taylor BC, Schousboe JT, Gourlay M, Osteoporotic Fractures in Men (MrOS) and Study of Osteoporotic Fractures (SOF) Research Groups
Schousboe JT, Gourlay M, Fink HA, Taylor BC, Orwoll ES, Barrett-Connor E, Melton LJ 3rd, Cummings SR, Ensrud KE, Osteoporotic Fractures in Men (MrOS) and Study of Osteoporotic Fractures (SOF) Research Groups. Cost-effectiveness of bone densitometry among Caucasian women and men without a prior fracture according to age and body weight. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 2013 Jan.

Abstract

We used a microsimulation model to estimate the threshold body weights at which screening bone densitometry is cost-effective. Among women aged 55-65 years and men aged 55-75 years without a prior fracture, body weight can be used to identify those for whom bone densitometry is cost-effective. BACKGROUND: Bone densitometry may be more cost-effective for those with lower body weight since the prevalence of osteoporosis is higher for those with low body weight. Our purpose was to estimate weight thresholds below which bone densitometry is cost-effective for women and men without a prior clinical fracture at ages 55, 60, 65, 75, and 80 years. METHODS: We used a microsimulation model to estimate the costs and health benefits of bone densitometry and 5 years of fracture prevention therapy for those without prior fracture but with femoral neck osteoporosis (T-score ≤ -2.5) and a 10-year hip fracture risk of ≥3%. Threshold pre-test probabilities of low BMD warranting drug therapy at which bone densitometry is cost-effective were calculated. Corresponding body weight thresholds were estimated using data from the Study of Osteoporotic Fractures (SOF), the Osteoporotic Fractures in Men (MrOS) study, and the National Health and Nutrition Examination Survey (NHANES) for 2005-2006. RESULTS: Assuming a willingness to pay of $75,000 per quality adjusted life year (QALY) and drug cost of $500/year, body weight thresholds below which bone densitometry is cost-effective for those without a prior fracture were 74, 90, and 100 kg, respectively, for women aged 55, 65, and 80 years; and were 67, 101, and 108 kg, respectively, for men aged 55, 75, and 80 years. CONCLUSIONS: For women aged 55-65 years and men aged 55-75 years without a prior fracture, body weight can be used to select those for whom bone densitometry is cost-effective.