Maximising the cost effectiveness of BMD referral for DXA using ultrasound as a selective population pre-screen

Langton, Christian; Ballard, Paul; Langton, D. K.; Purdie, D. W.

doi:10.3233/thc-1997-5306

Cited by 33 publications

(13 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The estimated cost of performing a DXA in our local department and other centres is £45 (20). The cost of the GP open access DXA service is therefore £26,370 per year.…”

Section: Discussionmentioning

confidence: 99%

An analysis of an open access general practitioner bone densitometry service

Sim

Stone

Johansen

et al. 2004

International Journal of Clinical Practice

View full text Add to dashboard Cite

General practitioners (GPs) are increasingly involved in the selective opportunistic case finding of osteoporosis and treatment of this condition. An open access bone densitometry service has existed for GPs in the Cardiff area since 1993. The purpose of this study was to assess the effectiveness of this service, particularly with respect to the appropriateness of bone densitometry requests and the impact of the service on hospital outpatient referrals. Over a period of 12 months, 560 patients were referred to the open access service by 154 GPs. A total of 229 (41%) patients were given a clinical diagnosis of osteoporosis. Four hundred and seventy-three (84%) referrals followed the clinical referral criteria. In 85% of cases, GPs claimed that they would have referred patients to the hospital outpatient department, if there were no open access bone densitometry service. The majority of the referrals were appropriate, and the service appears to have reduced GP referrals to the specialist clinic.

show abstract

“…The estimated cost of performing a DXA in our local department and other centres is £45 (20). The cost of the GP open access DXA service is therefore £26,370 per year.…”

Section: Discussionmentioning

confidence: 99%

An analysis of an open access general practitioner bone densitometry service

Sim

Stone

Johansen

et al. 2004

International Journal of Clinical Practice

View full text Add to dashboard Cite

show abstract

“…However, it is important to examine whether the proportion of misdiagnosed patients is small enough to offset the cost of identifying them and whether this additional knowledge enhances the prognostic information and changes the treatment strategy. Although there have been limited studies of the cost‐effectiveness of the use of BMD, (1, 28) Black et al (14) compared the risk of hip fractures using BMD of the femoral neck and lumbar spine. They found that by altering the cut‐off values of the T score to −2.2 for femoral neck BMD, they could get a classification with the same risk prediction power as using either a neck or spine BMD with a T score less than −2.5.…”

Section: Discussionmentioning

confidence: 99%

Classification of Osteoporosis Based on Bone Mineral Densities

Lü

Genant

Shepherd

et al. 2001

Journal of Bone and Mineral Research

146

View full text Add to dashboard Cite

In this article we examine the role of bone mineral density (BMD) in the diagnosis of osteoporosis. Using information from 7671 women in the Study of Osteoporotic Fractures (SOF) with BMD measurements at the proximal femur, lumbar spine, forearm, and calcaneus, we examine three models with differing criteria for the diagnosis of osteoporosis. Model 1 is based on the World Health Organization (WHO) criteria using a T score of ؊2.5 relative to the manufacturers' young normative data aged 20 -29 years, with modifications using information from the Third National Health and Nutrition Examination Survey (NHANES). Model 2 uses a T score of ؊1 relative to women aged 65 years at the baseline of the SOF population. Model 3 classifies women as osteoporotic if their estimated osteoporotic fracture risk (spine and/or hip) based on age and BMD is above 14.6%. We compare the agreement in osteoporosis classification according to the different BMD measurements for the three models. We also consider whether reporting additional BMD parameters at the femur or forearm improves risk assessment for osteoporotic fractures. We observe that using the WHO criteria with the manufacturers' normative data results in very inconsistent diagnoses. Only 25% of subjects are consistently diagnosed by all of the eight BMD variables. Such inconsistency is reduced by using a common elderly normative population as in model 2, in which case 50% of the subjects are consistently diagnosed as osteoporotic by all of the eight diagnostic methods. Risk-based diagnostic criteria as in model 3 improve consistency substantially to 68%. Combining the results of BMD assessments at more than one region of interest (ROI) from a single scan significantly increases prediction of hip and/or spine fracture risk and elevates the relative risk with increasing number of low BMD subregions. We conclude that standardization of normative data, perhaps referenced to an older population, may be necessary when applying T scores as diagnostic criteria in patient management. A risk-based osteoporosis classification does not depend on the manufacturers' reference data and may be more consistent and efficient for patient diagnosis.

show abstract

“…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: 96%

“…All studies reported that the DXA test was costlier than the QUS test, with some stating that the cost of the DXA test was ninefold or eightfold higher (28–31) and others reporting that it was twofold (32), threefold (31;32), fourfold (33), or fivefold higher (34) (Table 2).…”

Section: Resultsmentioning

confidence: 99%

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

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.

show abstract

Maximising the cost effectiveness of BMD referral for DXA using ultrasound as a selective population pre-screen

Cited by 33 publications

References 1 publication

An analysis of an open access general practitioner bone densitometry service

An analysis of an open access general practitioner bone densitometry service

Classification of Osteoporosis Based on Bone Mineral Densities

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

Contact Info

Product

Resources

About