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Screening Selected Older Men For Osteoporosis May Be Cost Effective

March 10, 2017

Screening selected elderly males with osteoporosis and treating them may be cost effective; their age has to be taken into account, according to an article published in the Journal of the American Medical Association (JAMA), August 8 issue.

Osteoporotic fractures are considered to be a widespread and severe health problem among elderly men. In fact, white males over 60 run a 29% chance of experiencing such a fracture during their twilight years, say the writers. Over 30% of all hip fractures happen to men - they are also as closely linked to a raised risk of death as they are for women. Even though the problem of osteoporosis in men is well known, there seems to be very little evidence regarding the cost-effectiveness of common diagnostic and therapeutic interventions.

John T. Schousboe, M.D., M.S., of Park Nicollet Health Services, Minneapolis, and carried out research to calculate the lifetime costs and health benefits of measuring bone density (bone densitometry) followed by 5 years of oral bisphosphonate therapy, using a type of drug used for strengthening bones, for male osteoporosis patients.

They created a computer simulation for hypothetical groups of white males aged 65, 70, 75, 80 or 85 - with or without a previous clinical fracture. They gathered information from several sources to estimate fracture costs and population-based age-specific fracture rates and associations among prior fractures, bone density and incident fractures. They then estimated the QALYs (costs per quality-adjusted life-years) gained for the bone densitometry and treatment that followed it compared to no intervention at all, calculated from lifetime costs and accumulated QALYs for each treatment strategy.

The scientists found that the estimated prevalence of femoral neck osteoporosis among older men who had suffered a fracture before ranged from 14.5% at 65 years of age, to 33.6% at 85 years. The prevalence of osteoporosis among men who had no prior clinical fracture ranged from 7.6% among the 65-year-olds to 17.6% among those aged 85. The bone densitometry followed by treatment strategy reduced the absolute 10-year incidence of clinical fracture modestly, ranging from 2.1% among those aged 65 years with no previous fractures to 4.5% among men aged 85 years who had had a previous fracture.

Cost-Effectiveness?

The authors concluded that "universal bone densitometry followed by oral bisphosphonate therapy among those found to have osteoporosis for all men aged 70 years or older regardless of fracture history or other fracture risk factors is not cost-effective using current drug costs. However, this strategy may be cost-effective for men aged 65 years or older with a prior clinical fracture and for men aged 80 years or older without a prior fracture, assuming a societal willingness to pay per QALY gained of $50,000. This densitometry and treatment strategy may also be cost-effective for white men aged 70 years or older without a prior clinical fracture if the cost of oral bisphosphonate therapy is less than $500 per year or if the societal willingness to pay per QALY gained is $100,000."

JAMA. 2007;298(6):629-637.

www.jama.ama-assn