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Erschienen in: Osteoporosis International 12/2020

11.08.2020 | Original Article

Vertebral fracture assessment (VFA) for osteoporosis screening in US postmenopausal women: is it cost-effective?

verfasst von: J. Yang, F. Cosman, P.W. Stone, M. Li, J.W. Nieves

Erschienen in: Osteoporosis International | Ausgabe 12/2020

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Abstract

Summary

Vertebral fracture assessment (VFA) is cost-effective when it was incorporated in the routine screening for osteoporosis in community-dwelling women aged ≥ 65 years, which support guidelines, such as the National Osteoporosis Foundation (NOF) for the diagnostic use of VFA as an important addition to fracture risk assessment.

Introduction

To evaluate the cost-effectiveness of VFA as a screening tool to reduce future fracture risk in US community–dwelling women aged ≥ 65 years.

Methods

An individual-level state-transition cost-effectiveness model from a healthcare perspective was constructed using derived data from published literature. The time horizon was lifetime. Five screening strategies were compared, including no screening at all, central dual-energy X-ray absorptiometry (DXA) only, VFA only, central DXA followed by VFA if the femoral neck T-score (FN-T) ≤ − 1.5, or if the FN-T ≤ − 1.0. Various initiation ages and rescreening intervals were evaluated. Oral bisphosphonate treatment for 5-year periods was assumed. Incremental cost-effectiveness ratios (2017 US dollars per quality-adjusted life-year (QALY) gained) were used as the outcome measure.

Results

The incorporation of VFA slightly increased life expectancy by 0.1 years and reduced the number of subsequent osteoporotic fractures by 3.7% and 7.7% compared with using DXA alone and no screening, respectively, leading to approximately 30 billion dollars saved. Regardless of initiation ages and rescreening intervals, central DXA followed by VFA if the FN-T ≤ − 1.0 was most cost-effective ($40,792 per QALY when the screening is initiated at age 65 years and with rescreening every 5 years). Results were robust to change in VF incidence and medication costs.

Conclusion

In women aged ≥ 65 years, VFA is cost-effective when it was incorporated in routine screening for osteoporosis. Our findings support the National Osteoporosis Foundation (NOF) guidelines for the diagnostic use of VFA as an important addition to fracture risk assessment.
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Metadaten
Titel
Vertebral fracture assessment (VFA) for osteoporosis screening in US postmenopausal women: is it cost-effective?
verfasst von
J. Yang
F. Cosman
P.W. Stone
M. Li
J.W. Nieves
Publikationsdatum
11.08.2020
Verlag
Springer London
Erschienen in
Osteoporosis International / Ausgabe 12/2020
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-020-05588-6

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