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Inclusion
of bone strength testing using CT to DXA dual-energy x-ray absorptiometry
screening would be cost-saving and will also decrease the chances of fragility
fractures in postmenopausal women with osteoporosis.
Are you suffering from the problem of fragile and weak bones?? If
yes, you may have osteoporosis. The diagnosis of this issue is very crucial.
For its diagnosis, various techniques are used such as MRI, DXA and CT
(computed tomography) scan. The risk of fracture is more likely to diagnose by
measuring BMD (bone mineral density), which is commonly assessed by performing
DXA (dual-energy x-ray absorptiometry). Scientists now want to evaluate whether
CT in combination with DXA is cost-effective as a screening tool for bone
strength among postmenopausal women or not.
For the study, an osteoporotic state-transition microsimulation model for
postmenopausal women was developed. This was developed with a lifetime horizon
and U.S. societal perspective. The women who selected for study was about 55
years old or older than 55. Published literature was used to derive all model
inputs. Scientists categorized study into three parts for comparison – no
screening, DXA with T score-dependent rescreening intervals, and DXA and
quantitative CT combination at different screening initiation age along with
different time intervals (3, 5, and 10 years). During evaluation, the
participants who had low DXA hip T scores, 10-year hip fracture risk more than
3%, 10-year major osteoporotic fracture risk more than 20%, in case of first
fracture, or quantitative CT femur bone strength was lower than 3000 N, were
known to provide oral bisphosphonate therapy. The outcomes involved in the
study were number of fragility fractures and ICERs (incremental
cost-effectiveness ratios) in 2015 U.S. dollars per quality-adjusted life year
(QALY) gained. Scientists also executed Probabilistic sensitivity analysis.
According to result evaluation, combined DXA and quantitative CT screening
cost-effective strategy was starting at 55 age that followed every 5
years. This strategy helped in sustaining
hip fractures among 12.8% of postmenopausal women in their remaining life.
Except this, other types of fractures were also evaluated. The vertebral
fracture percentages that came out was 7.5% for DXA and quantitative CT with a
5-year interval, 11.1% during no screening and 9% for DXA screening; for wrist
fractures 14%, 17.8%, and 16.4% and for other fractures the percentage was
22.6%, 30.8%, and 27.3%, respectively. Further, during probabilistic
sensitivity analysis, the DXA and quantitative CT at age 55 years with
quantitative CT screening at every 5 years determined as the best strategy in
more than 90% of all 1000 simulations. This can be seen from thresholds values
which was $50 000 per QALY at age of 55
and $100 000 per QALY after 5 years.
This whole study is very helpful in evaluating cost-effectiveness. This
combined DXA and quantitative CT strategy is very cost-effective for screening
osteoporosis among postmenopausal women.
Radiology. 2017 Jun 14:161259
Cost-effectiveness of Virtual Bone Strength Testing in Osteoporosis Screening Programs for Postmenopausal Women in the United States
Agten CA et al.
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