Cost-effectiveness of Screening for Osteoporosis in Older Men With a History of Falls

Show simplified metadata
dc.contributor.authorIto, Kouta
dc.contributor.departmentMeyers Primary Care Institute
dc.contributor.departmentDepartment of Medicine, Division of Geriatric Medicine
dc.date2022-08-11T08:09:58.000
dc.date.accessioned2022-08-23T16:50:45Z
dc.date.available2022-08-23T16:50:45Z
dc.date.issued2020-12-01
dc.date.submitted2021-02-16
dc.description.abstractImportance: 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.
dc.identifier.citation<p>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. <a href="https://doi.org/10.1001/jamanetworkopen.2020.27584">Link to article on publisher's site</a></p>
dc.identifier.contextkey21681415
dc.identifier.doi10.1001/jamanetworkopen.2020.27584
dc.identifier.issn2574-3805 (Linking)
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/oapubs/4511
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=5541&amp;context=oapubs&amp;unstamped=1
dc.identifier.pmid33258906
dc.identifier.submissionpathoapubs/4511
dc.identifier.urihttps://hdl.handle.net/20.500.14038/41720
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=33258906&dopt=Abstract">Link to Article in PubMed</a></p>
dc.rightsCopyright 2020 Ito K. JAMA Network Open. This is an open access article distributed under the terms of the CC-BY License.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.source.issue12
dc.source.journaltitleJAMA network open
dc.source.pagese2027584
dc.source.volume3
dc.subjectfall history
dc.subjectosteoporosis
dc.subjectmen
dc.subjectscreening
dc.subjectcost-effectiveness
dc.subjectDiagnosis
dc.subjectGeriatrics
dc.subjectHealth Economics
dc.subjectMusculoskeletal Diseases
dc.titleCost-effectiveness of Screening for Osteoporosis in Older Men With a History of Falls
dc.typeJournal Article
dspace.entity.typePublication
html.description.abstract<p>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.</p> <p>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.</p> <p>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.</p> <p>Interventions: Screening with DXA followed by treatment for men diagnosed with osteoporosis compared with usual care.</p> <p>Main Outcomes and Measures: Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained.</p> <p>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.</p> <p>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.</p>
refterms.dateFOA2022-08-23T16:50:45Z
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
ito_2020_oi_200889_1606759122.50926.pdf
Size:
984.24 KB
Format:
Adobe Portable Document Format
Download
Collections
UMass Chan Faculty and Researcher Publications