Osteoporosis screening, therapy is cost effective

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Screening all postmenopausal women for Osteoporosis, or thinning of the bones, using bone densitometry and treatment of women found to have this condition is highly cost effective, regardless of age.

“Even among the oldest of the elderly, bone densitometry and treatment of those with Osteoporosis is worthwhile,” said Dr. John T. Schousboe from Park Nicollet Health Services, Minneapolis, Minnesota.

"Organizing processes of care to encourage widespread bone densitometry among women age 65 and older and treatment of those found to have Osteoporosis is highly cost-effective and necessary if we are to make better progress reducing the health burden of osteoporotic fractures.”

Schousboe and colleagues investigated the lifetime health benefits and costs from a societal perspective of screening all women 65 years of age or older for osteoporosis, followed by treatment with alendronate (Fosamax) for those with hip density scores indicating bone thinning.

Not only did this strategy cost less than $50,000 per quality-adjusted life-year (QALY) gained at all ages, the authors report in the Journal of the American Geriatrics Society, but also the cost effectiveness improved with increasing age.

For 65-year-old women, the cost per QALY gained exceeded $50,000 only with substantially lower assumed fracture rates than published values or with treatment adherence rates below 75 percent, the report indicates.

Additional analyses indicate that there is nearly a 50-percent chance that the screen-and-treat strategy would be cost saving for 85-year-old women, the researchers note, whereas the probability of cost saving exceeds 75 percent for 95-year-old women.

A secondary analysis that considered nursing home residents separately reached similar conclusions. For 85-year-old nursing home residents, the strategy would cost an estimated $7,340 per QALY gained, the investigators observe, and the strategy would be cost saving for 95-year-old nursing home residents.

Improved screening and adherence to treatment are critical to ensuring the success of the screen-and-treat strategy, Schousboe said. He offered three suggestions for improving screening:

“Establish better care processes within health care systems. For example, for those who have an electronic medical record, having prompts to the primary care provider for those postmenopausal women age 65 and older who have not had a bone density test.”

“If ‘pay for performance’ comes on line, having performance of bone densitometry when indicated as one of the criteria by which the quality of a provider’s care is judged.”

“For nursing homes, having an assessment as to whether or not a prior bone density test has been done at the time of admission as part of the admitting nurse assessment.”

How can we improve adherence to treatment with alendronate and other bisphosphonates? “This is a very tough but important question,” Schousboe noted.

“The larger answer may lie in the level of trust the patient has in her provider; better education regarding the health consequences of fractures and the long-term safety record of available medications; and ongoing reinforcement regarding the role medication can play in reducing fracture risk,” he said.

SOURCE: Journal of the American Geriatrics Society, October 2005.

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