Cost-Effectiveness of Using Clinical Risk Factors with and without DXA for Osteoporosis Screening in Postmenopausal Women

Müeller, Dirk; Gandjour, Afschin

doi:10.1111/j.1524-4733.2009.00577.x

Cited by 26 publications

(17 citation statements)

References 54 publications

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“…The remaining studies considered either compliance or persistence or did not consider any aspect of nonadherence. When tested in sensitivity analyses, adherence did not affect the results considerably [38,42,46,51,53,54]. The conclusion of a negligible impact of medication adherence on the cost-effectiveness ratio, however, is debatable because in most studies not all aspects of adherence were taken into account.…”

Section: Discussionmentioning

confidence: 79%

“…While one model [57] referred to a NICE model published in 2002, three models [50,52,55] referred to a reference model recommended by the IOF [27]. The models from Schousboe et al and Muller et al were published for the first time in 2007-2008 and resulted in three [8,41,46] and four [38,51,53,54] analyses, respectively. While about two-third of the analyses were based on Markov cohort models, one quarter was based on microsimulation models.…”

Section: Characteristics Of the Analysesmentioning

confidence: 97%

“…While about two-third of the analyses were based on Markov cohort models, one quarter was based on microsimulation models. In two Markov models, the no-memory assumption of the method was avoided by using tunnel techniques for health states [25] or by creating additional health states [38,51,53,54]. About half of the analyses were conducted from a societal perspective.…”

Section: Characteristics Of the Analysesmentioning

confidence: 99%

“…Four analyses [38,51,53,54] used a model based on an algorithm developed by the German osteology umbrella organization [61]. Estimates of fracture probabilities are very similar to the FRAX tool and were based on prior fractures, a parental history of fracture, immobility, underweight, smoking, and multiple falls.…”

Section: Analyses Based On Variable Thresholdsmentioning

confidence: 99%

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Cost-Effectiveness of Different Strategies for Selecting and Treating Individuals at Increased Risk of Osteoporosis or Osteopenia: A Systematic Review

2012

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Risk assessment using variable thresholds appears to be more cost-effective than selecting high-risk individuals by fixed thresholds. Although the overall quality of the studies was fairly good, future economic analyses should further improve their methods, particularly in terms of including more fracture types, incorporating medication adherence, and including or discussing unrelated costs during added life-years.

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Section: Discussionmentioning

confidence: 79%

Section: Characteristics Of the Analysesmentioning

confidence: 97%

Section: Characteristics Of the Analysesmentioning

confidence: 99%

Section: Analyses Based On Variable Thresholdsmentioning

confidence: 99%

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Cost-Effectiveness of Different Strategies for Selecting and Treating Individuals at Increased Risk of Osteoporosis or Osteopenia: A Systematic Review

2012

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“…Six diagnostic papers indicated that Markov modelling is a useful approach to estimate transitions between different health states depending on diagnosis and treatment [38,46], with one study also including failure to diagnose as a decision outcome [47]. O'Connor and Knoblauch [48] described the use of reports, detailing the proportion of people diagnosed and the anticipated life expectancy as a result of diagnosis, to model cost effectiveness.…”

Section: Accounting For Distance From Outcomesmentioning

confidence: 99%

A Review of the Economic Tools for Assessing New Medical Devices

Craig

Carr

Hutton

et al. 2014

Appl Health Econ Health Policy

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Whereas the economic evaluation of pharmaceuticals is an established practice within international health technology assessment (HTA) and is often produced with the support of comprehensive methodological guidance, the equivalent procedure for medical devices is less developed. Medical devices, including diagnostic products, are a rapidly growing market in healthcare, with over 10,000 medical technology patent applications filed in Europe in 2012-nearly double the number filed for pharmaceuticals. This increase in the market place, in combination with the limited, or constricting, budgets that healthcare decision makers face, has led to a greater level of examination with respect to the economic evaluation of medical devices. However, methodological questions that arise due to the unique characteristics of medical devices have yet to be addressed fully. This review of journal publications and HTA guidance identified these characteristics and the challenges they may subsequently pose from an economic evaluation perspective. These unique features of devices can be grouped into four categories: (1) data quality issues; (2) learning curve; (3) measuring long-term outcomes from diagnostic devices; and (4) wider impact from organisational change. We review the current evaluation toolbox available to researchers and explore potential future approaches to improve the economic evaluation of medical devices.

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An economic evaluation: Simulation of the cost-effectiveness and cost-utility of universal prevention strategies against osteoporosis-related fractures

Nshimyumukiza

Durand

Gagnon

et al. 2012

Journal of Bone and Mineral Research

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A patient-level Markov decision model was used to simulate a virtual cohort of 500,000 women 40 years old and over, in relation to osteoporosis-related hip, clinical vertebral, and wrist bone fractures events. Sixteen different screening options of three main scenario groups were compared: (1) the status quo (no specific national prevention program); (2) a universal primary prevention program; and (3) a universal screening and treatment program based on the 10-year absolute risk of fracture. The outcomes measured were total directs costs from the perspective of the public health care system, number of fractures, and quality-adjusted life-years (QALYs). Results show that an option consisting of a program promoting physical activity and treatment if a fracture occurs is the most cost-effective (CE) (cost/fracture averted) alternative and also the only cost saving one, especially for women 40 to 64 years old. In women who are 65 years and over, bone mineral density (BMD)-based screening and treatment based on the 10-year absolute fracture risk calculated using a Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool is the best next alternative. In terms of cost-utility (CU), results were similar. For women less than 65 years old, a program promoting physical activity emerged as cost-saving but BMD-based screening with pharmacological treatment also emerged as an interesting alternative. In conclusion, a program promoting physical activity is the most CE and CU option for women 40 to 64 years old. BMD screening and pharmacological treatment might be considered a reasonable alternative for women 65 years old and over because at a healthcare capacity of $50,000 Canadian dollars ($CAD) for each additional fracture averted or for one QALY gained its probabilities of cost-effectiveness compared to the program promoting physical activity are 63% and 75%, respectively, which could be considered socially acceptable. Consideration of the indirect costs could change these findings.

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Cost-Effectiveness of Using Clinical Risk Factors with and without DXA for Osteoporosis Screening in Postmenopausal Women

Abstract: Funders should be careful in adopting a strategy based on CRFs alone instead of DXA plus CRFs. Only if DXA is not available, assessing CRFs only is an acceptable option in predicting a woman's risk of fracture.

Cited by 26 publications

References 54 publications

Cost-Effectiveness of Different Strategies for Selecting and Treating Individuals at Increased Risk of Osteoporosis or Osteopenia: A Systematic Review

Cost-Effectiveness of Different Strategies for Selecting and Treating Individuals at Increased Risk of Osteoporosis or Osteopenia: A Systematic Review

A Review of the Economic Tools for Assessing New Medical Devices

An economic evaluation: Simulation of the cost-effectiveness and cost-utility of universal prevention strategies against osteoporosis-related fractures

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