In new research presented at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases today, investigators showed that an osteoporosis screening strategy using FRAX as a pre-screening tool is cost-effective if the follow up of the screening and medication adherence are optimized. FRAX (WHO Fracture Risk Assessment Tool) is a widely used algorithm to determine 10-year risk of fracture based on an individual's risk factors.
Researchers from the University of Maastricht and the University of Li-ge evaluated the cost-effectiveness of an osteoporosis screening campaign in the Province of Li-ge (Belgium). A previously validated microsimulation model was used to estimate the incremental cost-effectiveness ratio (ICER), expressed in costs (in -) per quality-adjusted life-year gained (QALY) gained, of the screening/treatment strategy versus no intervention. The screening/treatment strategy consisted of pre-screening using FRAX, followed by a bone densitometry for patients with a positive FRAX result and combined with a 5-year branded alendronate therapy for women diagnosed with osteoporosis (bone mineral density (BMD) T-score≤−2.5).
The ICER for the screening/treatment strategy versus no intervention in the whole population (mean age=60 years) was estimated at €66,665 and €39,504 per QALY gained assuming real-world and full adherence respectively. ICERs decreased to €55,517 and €28,520 in the population aged over 60 years (mean age= 65 years). The ICER of the screening strategy decreases when improving the follow-up of a positive screening and when increasing fracture risk. Using the price of generic alendronate, the cost-effectiveness improved to €50,880 and €32,293 assuming real-world and full adherence, respectively.
The authors therefore conclude that the osteoporosis screening strategy is cost-effective if the follow up of the screening and medication adherence are optimized. Therefore, BMD should be performed in all individuals with posi-tive FRAX score; individuals having a positive BMD diagnosis should be treated and adherence to therapy should be optimized.
Doctor Micka-l Hiligsmann, Assistant Professor in Health Economics and Health Technology Assessment at Maastricht University and Invited Professor at University of Li-ge, stated, "To further improve the cost-effectiveness of the screening strategy, we suggest targeting screening on women with one or more clinical risk factors, or on women aged 65 years and older".
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