UMMS Affiliation

Department of Medicine, Division of Geriatric Medicine; Meyers Primary Care Institute

Publication Date

2020-12-01

Document Type

Article

Disciplines

Diagnosis | Geriatrics | Health Economics | Musculoskeletal Diseases

Abstract

Importance: Falls and osteoporosis share the potential clinical end point of fractures among older patients. To date, few fall prevention guidelines incorporate screening for osteoporosis to reduce fall-related fractures.

Objective: To assess the cost-effectiveness of screening for osteoporosis using dual-energy x-ray absorptiometry (DXA) followed by osteoporosis treatment in older men with a history of falls.

Design, Setting, and Participants: In this economic evaluation, a Markov model was developed to simulate the incidence of major osteoporotic fractures in a hypothetical cohort of community-dwelling men aged 65 years who had fallen at least once in the past year. Data sources included literature published from January 1, 1946, to July 31, 2020. The model adopted a societal perspective, a lifetime horizon, a 1-year cycle length, and a discount rate of 3% per year for both health benefits and costs. The analysis was designed and conducted from October 1, 2019, to September 30, 2020.

Interventions: Screening with DXA followed by treatment for men diagnosed with osteoporosis compared with usual care.

Main Outcomes and Measures: Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained.

Results: Among the hypothetical cohort of men aged 65 years, the screening strategy had an ICER of $33169/QALY gained and was preferred over usual care at the willingness-to-pay threshold of $100000/QALY gained. The number needed to screen to prevent 1 hip fracture was 1876; to prevent 1 major osteoporotic fracture, 746. The screening strategy would become more effective and less costly than usual care for men 77 years and older. The ICER for the screening strategy did not substantially change across a wide range of assumptions tested in all other deterministic sensitivity analyses. At a willingness-to-pay threshold of $50000/QALY gained, screening was cost-effective in 56.0% of simulations; at $100000/QALY gained, 90.8% of simulations; and at $200000/QALY gained, 99.6% of simulations.

Conclusions and Relevance: These findings suggest that for older men who have fallen at least once in the past year, screening with DXA followed by treatment for those diagnosed with osteoporosis is a cost-effective use of resources. Fall history could be a useful cue to trigger assessment for osteoporosis in men.

Keywords

fall history, osteoporosis, men, screening, cost-effectiveness

Rights and Permissions

Copyright 2020 Ito K. JAMA Network Open. This is an open access article distributed under the terms of the CC-BY License.

DOI of Published Version

10.1001/jamanetworkopen.2020.27584

Source

Ito K. Cost-effectiveness of Screening for Osteoporosis in Older Men With a History of Falls. JAMA Netw Open. 2020 Dec 1;3(12):e2027584. doi: 10.1001/jamanetworkopen.2020.27584. PMID: 33258906; PMCID: PMC7708999. Link to article on publisher's site

Journal/Book/Conference Title

JAMA network open

Related Resources

Link to Article in PubMed

PubMed ID

33258906

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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