Comparison of accuracy and cost effectiveness of clinical criteria and BUA for referral for BMD assessment by DXA in osteoporotic and osteopenic perimenopausal subjects

Langton, Christian; Langton, D. K.; Beardsworth, S. A.

doi:10.3233/thc-1999-7501

Cited by 14 publications

(7 citation statements)

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“…According to Langton et al (28;29) and Marín et al (30), the cost per true positive case diagnosed by DXA was higher than that for diagnosis by QUS+DXA. Kraemer et al (33), however, estimated that the cost per osteoporotic subject identified by DXA alone was less than the cost per osteoporotic subject identified by QUS+DXA.…”

Section: Resultsmentioning

confidence: 97%

“…As the prevalence of osteoporosis within a population increases, the total screening cost is divided over a large number of osteoporotic subjects and the cost per subject identified decreases. Hence, the cost per true positive case diagnosed by DXA in Langton et al 1999 (29) was 967.83 Euros for the 50–54 year cohort, falling to 312.52 Euros for the 60–69 year cohort in Langton et al 1997 (28).…”

Section: Discussionmentioning

confidence: 94%

“…This could be explained by the range in the QUS sensitivity and specificity, between 33 percent and 93 percent and between 24 percent and 93 percent, respectively, so that the cost per true positive case diagnosed by QUS+DXA was higher when there were many false positives or there was low QUS sensitivity; (iv) a significant factor in the cost per true positive case is the prevalence of osteoporosis at the different ages. Langton et al 1999 (29) showed that for women aged 50–55, the prevalence of osteoporosis was only 7.85 percent, whereas Langton et al 1997 (28) found that the prevalence for women aged 60–69 was 24.3 percent. As the prevalence of osteoporosis within a population increases, the total screening cost is divided over a large number of osteoporotic subjects and the cost per subject identified decreases.…”

Section: Discussionmentioning

confidence: 99%

“…In this review, the process of critically appraising health economic evaluation studies assisted by Drummond checklists showed that the quality of published health economic evaluations varies. Some studies did not provide sufficient evidence for decision makers in the countries in which they were conducted: for example, Langton et al (28;29) in the United Kingdom and Kramer et al (33) in the United States did not provide details of the costs of the two tests and did not justify the types of costs used, and Hiligsmann et al (34) in Belgium did not use a sensitivity analysis. Thus, decision makers cannot judge if the findings are applicable to their health service or social insurance.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Techniques for Diagnosing Osteoporosis: A Systematic Review of Cost-Effectiveness Studies

Minniti

Davini

Gualano

et al. 2014

Int J Technol Assess Health Care

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Objectives. The study question was whether dual-energy X-ray absorptiometry (DXA) alone is more costeffective for identifying postmenopausal women with osteoporosis than a two-step procedure with quantitative ultrasound sonography (QUS) plus DXA. To answer this question, a systematic review was performed.Methods. Electronic databases (PubMed, INAHTA, Health Evidence Network, NIHR, the Health Technology Assessment programme, the NHS Economic Evaluation Database, Research Papers in Economics, Web of Science, Scopus, and EconLit) were searched for cost-effectiveness publications. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using the Drummond checklist.Results. Seven journal articles and four reports were reviewed. The cost per true positive case diagnosed by DXA was found to be higher than that for diagnosis by QUS+DXA in 2 articles. In one article it was found to be lower. In three studies the results were not conclusive. These articles were characterised by the differences in the types of devices, parameters and thresholds on the QUS and DXA tests and the unit costs of the DXA and QUS tests as well as by variability in the sensitivity and specificity of the techniques and the prevalence of osteoporosis. Conclusions.The publications reviewed did not provide clear-cut evidence for drawing conclusions about which screening test may be more cost-effective for identifying postmenopausal women with osteoporosis.

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Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Techniques for Diagnosing Osteoporosis: A Systematic Review of Cost-Effectiveness Studies

Minniti

Davini

Gualano

et al. 2014

Int J Technol Assess Health Care

View full text Add to dashboard Cite

show abstract

“…QUS parameters have been shown to be much better predictors of women with low bone mass than clinical risk factors. [31][32][33][34] In other words, postmenopausal women could be selected more effectively for assessment of axial BMD based on QUS measurements rather than clinical risk factors. However, one study has suggested that this is not a cost-effective approach.…”

Section: Can Qus Be Used To Target Women For Axial Bmd Assessment?mentioning

confidence: 99%

Quantitative Ultrasound in Osteoporosis

Stewart¹,

Reid²

2002

Semin Musculoskelet Radiol

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Quantitative ultrasound (QUS) has been applied to the assessment of bone for almost two decades. The physical interaction of ultrasound and bone is complex and not completely understood. However, it is considered that QUS provides information on bone mass and structure. Although dual-energy X-ray absorptiometry (DXA) is currently considered the "gold standard" for the diagnosis of osteoporosis, through the World Health Organisation definition, there is, in some parts of the world, limited availability to axial DXA. This has stimulated interest in smaller, more portable, and less expensive techniques to indentify those at risk of osteoporotic fracture. One such quantitative method is QUS, which has the added advantage over other photon absorptiometric bone density techniques of not using ionizing radiation. This article reviews the capabilities of QUS and indicates its appropriate application in clinical practice, based on current review of the scientific literature.

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Is calcaneal quantitative ultrasound useful as a prescreen stratification tool for osteoporosis?

et al. 2015

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Calcaneal quantitative ultrasound (QUS) is attractive as a prescreening tool for osteoporosis, alternative to dual-energy X-ray absorptiometry. We investigated the literature of the usability of calcaneal QUS. We found large heterogeneity between studies and uncertainty about cutoff, device, and measured variable. Despite osteoporosis-related fractures being a major health issue, osteoporosis remains underdiagnosed. Dual-energy X-ray absorptiometry (DXA) of the hip or spine is currently the preferred method for diagnosis of osteoporosis, but the method is limited by low accessibility. QUS is a method for assessing bone alternative to DXA. The aim of this systematic review was to explore the usability of QUS as a prescreen stratification tool for assessment of osteoporosis. Studies that evaluated calcaneal QUS with DXA of the hip or spine as the gold standard was included. We extracted data from included studies to calculate number of DXAs saved and misclassification rates at cutoffs equal to high sensitivity and/or specificity. The number of DXAs saved and percentage of persons misclassified were measures of usability. We included 31 studies. Studies were heterogeneous regarding study characteristics. Analyses showed a wide spectrum of percentage of DXAs saved (2.7-68.8%) and misclassification rates (0-12.4%) depending on prescreen strategy and study characteristics, device, measured variable, and cutoff. Calcaneal QUS is potentially useful as a prescreen tool for assessment of osteoporosis. However, there is no consensus of device, variable, and cutoff. Overall, there is no sufficient evidence to recommend a specific cutoff for calcaneal QUS that provides a certainty level high enough to rule in or out osteoporosis. Calcaneal QUS in a prescreen or stratification algorithm must be based on device-specific cutoffs that are validated in the populations for which they are intended to be used.

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Comparison of accuracy and cost effectiveness of clinical criteria and BUA for referral for BMD assessment by DXA in osteoporotic and osteopenic perimenopausal subjects

Cited by 14 publications

References 0 publications

Techniques for Diagnosing Osteoporosis: A Systematic Review of Cost-Effectiveness Studies

Techniques for Diagnosing Osteoporosis: A Systematic Review of Cost-Effectiveness Studies

Quantitative Ultrasound in Osteoporosis

Is calcaneal quantitative ultrasound useful as a prescreen stratification tool for osteoporosis?

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