Using the Osteoporosis Self-Assessment Tool for Referring Older Men for Bone Densitometry: A Decision Analysis
Article first published online: 6 JAN 2009
© 2009, Copyright the Authors. Journal compilation © 2009, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 57, Issue 2, pages 218–224, February 2009
How to Cite
Ito, K., Hollenberg, J. P. and Charlson, M. E. (2009), Using the Osteoporosis Self-Assessment Tool for Referring Older Men for Bone Densitometry: A Decision Analysis. Journal of the American Geriatrics Society, 57: 218–224. doi: 10.1111/j.1532-5415.2008.02110.x
- Issue published online: 28 JAN 2009
- Article first published online: 6 JAN 2009
- cost-effectiveness analysis;
OBJECTIVES: To compare health benefits and costs associated with performing bone densitometry for all men with those of risk-stratifying using the Osteoporosis Self-Assessment Tool (OST) and performing bone densitometry only for a high-risk group.
DESIGN: A decision analytical model was developed using a Markov process. Three strategies were compared: no bone densitometry, selective bone densitometry using the OST, and universal bone densitometry. Data sources were U.S. epidemiological studies and healthcare cost figures.
SETTING: Hypothetical cohort.
PARTICIPANTS: Community-dwelling 70-year-old U.S. white men with no history of clinical osteoporotic fractures.
INTERVENTION: Five years of alendronate therapy for those diagnosed with osteoporosis.
MEASUREMENTS: Life years, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios.
RESULTS: Selective bone densitometry using the OST would cost $100,700 per additional life year gained compared to the no bone densitometry strategy. Universal bone densitometry would cost $483,500 for additional life year gained compared to selective bone densitometry. When quality of life was considered, both strategies became approximately 15% more cost-effective. Compared with the no bone densitometry strategy, selective bone densitometry would be cost saving for those aged 84 and older, with a reduction of alendronate price (≤$110 per year), or with a higher efficacy of alendronate (a relative risk reduction of nonvertebral fracture ≥82%).
CONCLUSION: Universal bone densitometry for 70-year-old men is not a good investment for society. It is reasonably cost-effective to risk-stratify with the OST, perform bone densitometry only for high-risk group, and then give men diagnosed with osteoporosis generic alendronate.