A community-based screening programme of fracture risk in older UK women represents a highly cost-effective intervention, say the authors of a new analysis published in the Journal of Bone and Mineral Research.
The research, led by the University of East Anglia, used data collected as part of the SCOOP study to estimate the cost-effectiveness of a screening intervention which combined the FRAX fracture risk assessment tool and dual-energy X-ray absorptiometry (DXA)-based bone mineral density (BMD) measurement when indicated.
The SCOOP screening programme assessed 10-year risk using the FRAX risk algorithm. Individuals judged to have sufficiently high risk were invited to undergo dual-energy X-ray absorptiometry (DXA)-based BMD measurement, and this information was used to recalculate the 10-year hip fracture probability. This information was communicated to the participant and their family doctor. The screening programme was found to substantially reduce the 5-year risk for hip fracture (HR=0.72; P=.002), though not fractures at other sites (HR=0.94; P=.178).
The current cost-effectiveness analysis found that the screening arm had an average incremental quality-adjusted life year (QALY) gain of 0.0237 (95% CI, -0.0034 to 0.0508). The incremental cost per QALY gained was £2772 compared with the control arm. The intervention arm prevented fractures at a cost of £4478 per osteoporosis-related fracture and £7694 per hip fracture. Cost-effectiveness acceptability curves indicated a 93% probability of the intervention being cost-effective at values of a QALY greater than £20,000.
“The current study provides strong evidence that community screening, based on the FRAX probability of hip fracture in older women, would likely be cost-effective and represent an efficient use of healthcare resources,” the authors said.
