Cost-Effectiveness of Osteoporosis Screening in Women Over 40-Year-Old
Abstract
Osteoporosis is a disease recognized by bone density reduction and is particularly common among older women, which imposes them to fractures. The evidence shows that if do no serious conflict with this issue, in the far little future, huge costs will be imposed on individuals, families, and the country. In this study, we studied the cost-effectiveness of osteoporosis screening in women over 40 years of age in Shiraz in 2016. This cross-sectional study was performed on 240 persons who were screened and 240 non-screened persons in the bone mineral density ward of Shiraz Namazi Hospital. The costs were identified and from the perspective of the insurer and the payer, which included only direct health care costs. To measure the effectiveness, the use of indicators as quality-adjusted life-years (QALY), the expected cost and effectiveness, and the Incremental cost-effectiveness ratio were calculated. The results showed that non-screening is the best strategy, given that the amount of ICER was obtained at $38484.56 and the threshold. As a result, the non-screening method compared to screening is cost-effective. The relevant authorities and proficients should prevent the progression of disease complications and consequently prevent the increase of the disease cost and improve the quality of life of the patients.
1. Johnell O, Hertzman P. What evidence is there for the prevention and screening of osteoporosis? Copenhagen, WHO Regional Office for Europe (Health Evidence Network report; http://www.euro.who.int/document/e88668.pdf, accessed 18 May 2006).
2. Agha mohammadzadeh N, Najafi poor F, Bahrami A, et al. Causes of bone density loss in patients with osteoporosis and osteopenia. Journal of Gorgan University of Medical Sciences. 2009; 11(2): 61-67. [in Persian]
3. Kling JM, Clarke BL, Sandhu NP. Osteoporosis Prevention, Screening, and Treatment: A Review. Journal of Women’s Health, 2014; 7 (23): 563-572.
4. Hernlund E, Svedbom A, Ivergard M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos. 2013; 8(136): 1-115.
5. Wright NC, Looker AC, Saag KG, et al. The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine. J Bone Miner Res. 2014; 29(11): 1-15.
6. Herrera A, Mateo J, Gil-Albarova J, et al. Prevalence of osteoporotic vertebral fracture in Spanish women over age 45. Maturitas. 2015; 80: 288-295.
7. Bayat N, Haji amini Z, Alishiri GH, et al. Evaluation of the prevalence of osteoporosis and osteopenia in postmenopausal women of military families. Journal of Army University of Medical Sciences of the Islamic Republic of Iran. 2008; (1): 25-30. [in Persian]
8. Hiligsmann M, Gathon HJ, Bruyère O, et al. Cost–Effectiveness of Osteoporosis Screening Followed by Treatment: The Impact of Medication Adherence. Value in Health. 2010; 4(13): 394-401.
9. Mueller D, Gandjour A. Cost-Effectiveness of Using Clinical Risk Factors with and without DXA for Osteoporosis Screening in Postmenopausal Women. Value In Health. 2009; 8(12): 1106-1117.
10. Nayak S, Roberts M, Greenspan S. Cost-Effectiveness of Different Screening Strategies for Osteoporosis in Postmenopausal Women. Annals of Internal Medicine. 2011; 155: 751-761.
11. Nshimyumukiza L, Durand A, Gagnon M, et al. An Economic Evaluation: Simulation of the Cost-Effectiveness and Cost-Utility of Universal Prevention Strategies against Osteoporosis-Related Fractures. Journal of Bone and Mineral Research. 2013; 2(28): 383-394.
12. Darba J, Kaskens L, Perez-Alvarez N, et al. Disability-adjusted-life-years losses in postmenopausal women with osteoporosis: a burden of illness study. BMC Public Health. 2015; 15: 1-10.
13. Soheili azad AA, Yavari H, Azami M. The economic burden of hip fracture in patients referred to the orthopedic ward of Sina Hospital. Journal of Iran University of Medical Sciences. 2005; 12(47): 83-92. [in Persian]
14. Eghbali S, Nabi poor A, Dehghani Z. Prevalence of osteoporosis in women over 50 years of Bushehr port. South Medical Quarterly Periodical. 2009; 11(2): 163-169. [in Persian]
15. Motaghi P, Karim zadeh H, Bonakdar Z, et al. Evaluation of performance of the simple tool for calculating the risk of osteoporosis for screening Iranian menopausal women. Journal of Shahrekord University of Medical Sciences. 2010; 12(1): 26-31. [in Persian]
16. Shahnazari B, Keshtkar A, Soltani A, et al. Estimating the avoidable burden of certain modifiable risk factors in osteoporotic hip fracture using Generalized Impact Fraction (GIF) model in Iran. Journal of Diabetes & Metabolic Disorders. 2013; 12(10): 1-9.
17. Hajbagheri A, Abasinia M. Assessment of health related quality of life in elderly patients with femoral neck fracture with sf-36 and EQ5D. Journal of research in nursing. 2009; 4(15): 71-79.
18. Goudarzi R, Zeraati H, Akbarisari A, et al. Population-Based Preference Weights for the EQ-5D Health States Using the Visual Analogue Scale (VAS) in Iran. Iran Red Crescent Med J. 2016; 18(2): 1-9.
19. Eichler HG KS, Gerth WC, Mavros P, et al. Use of cost-effectiveness analysis in health care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge. Value Health. 2004; 7(5): 518-28.
20. World Bank national accounts data, and OECD National Accounts data files. available at : .http://data.worldbank.org/indicator/NY.GDP.PCAP.CD/countries/IR?display=default
21. The Central Bank of Iran (CBI) available at: www.cbi.ir
22. Taylor M. What is sensitivity analysis. Consortium YHE: University of York. 2009; 1-8.
23. Winzenberg LSI, Winzenberg TM, Chen M, et al. Screening for osteoporosis in Chinese post-menopausal women: a health economic modelling study. Osteoporos Int. 2016; 27: 2259–2269.
24. Capatina C, Poiana C. The quality of life in women with postmenopausal osteoporosis and the impact of falling. The Publishing House Of The Romanian Academy. 2017; 19 (2): 79-86.
25. Kown HY, Ha YC, Yoo J. Health-related Quality of Life in Accordance with Fracture History and Comorbidities in Korean Patients with Osteoporosis. Journal Bone Metab. 2016; 23: 199-206.
26. Hallberg I. Health-Related Quality of Life in Postmenopausal Women with Osteoporotic Fractures. Liu-Tryck Linkoping Sweden. 2009; 1-84.
27. Altinda O, Altinda A, Soran N, et al. Quality of Life and Depression in Postmenopausal Women with Osteoporosis. Turk J Phys Med Rehab. 2007; 53: 61-4.
28. Park H. The impact of osteoporosis on health-related quality of life in elderly women. Biomedical Research. 2018; 29 (16): 3223-3227.
29. Kingkaew P, Maleewong U, Ngarmukos Ch, et al. Evidence to Inform Decision Makers in Thailand: A Cost-Effectiveness Analysis of Screening and Treatment Strategies for Postmenopausal Osteoporosis. Value in Health. 2012; 15: 20-28.
30. Ito K, Blinder VS, Elkin EB. Cost Effectiveness of Fracture Prevention in Postmenopausal Women Who Receive Aromatase Inhibitors for Early Breast Cancer. Journal of Clinical Oncology. 2012; 13(30): 1468-1475.
2. Agha mohammadzadeh N, Najafi poor F, Bahrami A, et al. Causes of bone density loss in patients with osteoporosis and osteopenia. Journal of Gorgan University of Medical Sciences. 2009; 11(2): 61-67. [in Persian]
3. Kling JM, Clarke BL, Sandhu NP. Osteoporosis Prevention, Screening, and Treatment: A Review. Journal of Women’s Health, 2014; 7 (23): 563-572.
4. Hernlund E, Svedbom A, Ivergard M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos. 2013; 8(136): 1-115.
5. Wright NC, Looker AC, Saag KG, et al. The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine. J Bone Miner Res. 2014; 29(11): 1-15.
6. Herrera A, Mateo J, Gil-Albarova J, et al. Prevalence of osteoporotic vertebral fracture in Spanish women over age 45. Maturitas. 2015; 80: 288-295.
7. Bayat N, Haji amini Z, Alishiri GH, et al. Evaluation of the prevalence of osteoporosis and osteopenia in postmenopausal women of military families. Journal of Army University of Medical Sciences of the Islamic Republic of Iran. 2008; (1): 25-30. [in Persian]
8. Hiligsmann M, Gathon HJ, Bruyère O, et al. Cost–Effectiveness of Osteoporosis Screening Followed by Treatment: The Impact of Medication Adherence. Value in Health. 2010; 4(13): 394-401.
9. Mueller D, Gandjour A. Cost-Effectiveness of Using Clinical Risk Factors with and without DXA for Osteoporosis Screening in Postmenopausal Women. Value In Health. 2009; 8(12): 1106-1117.
10. Nayak S, Roberts M, Greenspan S. Cost-Effectiveness of Different Screening Strategies for Osteoporosis in Postmenopausal Women. Annals of Internal Medicine. 2011; 155: 751-761.
11. Nshimyumukiza L, Durand A, Gagnon M, et al. An Economic Evaluation: Simulation of the Cost-Effectiveness and Cost-Utility of Universal Prevention Strategies against Osteoporosis-Related Fractures. Journal of Bone and Mineral Research. 2013; 2(28): 383-394.
12. Darba J, Kaskens L, Perez-Alvarez N, et al. Disability-adjusted-life-years losses in postmenopausal women with osteoporosis: a burden of illness study. BMC Public Health. 2015; 15: 1-10.
13. Soheili azad AA, Yavari H, Azami M. The economic burden of hip fracture in patients referred to the orthopedic ward of Sina Hospital. Journal of Iran University of Medical Sciences. 2005; 12(47): 83-92. [in Persian]
14. Eghbali S, Nabi poor A, Dehghani Z. Prevalence of osteoporosis in women over 50 years of Bushehr port. South Medical Quarterly Periodical. 2009; 11(2): 163-169. [in Persian]
15. Motaghi P, Karim zadeh H, Bonakdar Z, et al. Evaluation of performance of the simple tool for calculating the risk of osteoporosis for screening Iranian menopausal women. Journal of Shahrekord University of Medical Sciences. 2010; 12(1): 26-31. [in Persian]
16. Shahnazari B, Keshtkar A, Soltani A, et al. Estimating the avoidable burden of certain modifiable risk factors in osteoporotic hip fracture using Generalized Impact Fraction (GIF) model in Iran. Journal of Diabetes & Metabolic Disorders. 2013; 12(10): 1-9.
17. Hajbagheri A, Abasinia M. Assessment of health related quality of life in elderly patients with femoral neck fracture with sf-36 and EQ5D. Journal of research in nursing. 2009; 4(15): 71-79.
18. Goudarzi R, Zeraati H, Akbarisari A, et al. Population-Based Preference Weights for the EQ-5D Health States Using the Visual Analogue Scale (VAS) in Iran. Iran Red Crescent Med J. 2016; 18(2): 1-9.
19. Eichler HG KS, Gerth WC, Mavros P, et al. Use of cost-effectiveness analysis in health care resource allocation decision-making: how are cost-effectiveness thresholds expected to emerge. Value Health. 2004; 7(5): 518-28.
20. World Bank national accounts data, and OECD National Accounts data files. available at : .http://data.worldbank.org/indicator/NY.GDP.PCAP.CD/countries/IR?display=default
21. The Central Bank of Iran (CBI) available at: www.cbi.ir
22. Taylor M. What is sensitivity analysis. Consortium YHE: University of York. 2009; 1-8.
23. Winzenberg LSI, Winzenberg TM, Chen M, et al. Screening for osteoporosis in Chinese post-menopausal women: a health economic modelling study. Osteoporos Int. 2016; 27: 2259–2269.
24. Capatina C, Poiana C. The quality of life in women with postmenopausal osteoporosis and the impact of falling. The Publishing House Of The Romanian Academy. 2017; 19 (2): 79-86.
25. Kown HY, Ha YC, Yoo J. Health-related Quality of Life in Accordance with Fracture History and Comorbidities in Korean Patients with Osteoporosis. Journal Bone Metab. 2016; 23: 199-206.
26. Hallberg I. Health-Related Quality of Life in Postmenopausal Women with Osteoporotic Fractures. Liu-Tryck Linkoping Sweden. 2009; 1-84.
27. Altinda O, Altinda A, Soran N, et al. Quality of Life and Depression in Postmenopausal Women with Osteoporosis. Turk J Phys Med Rehab. 2007; 53: 61-4.
28. Park H. The impact of osteoporosis on health-related quality of life in elderly women. Biomedical Research. 2018; 29 (16): 3223-3227.
29. Kingkaew P, Maleewong U, Ngarmukos Ch, et al. Evidence to Inform Decision Makers in Thailand: A Cost-Effectiveness Analysis of Screening and Treatment Strategies for Postmenopausal Osteoporosis. Value in Health. 2012; 15: 20-28.
30. Ito K, Blinder VS, Elkin EB. Cost Effectiveness of Fracture Prevention in Postmenopausal Women Who Receive Aromatase Inhibitors for Early Breast Cancer. Journal of Clinical Oncology. 2012; 13(30): 1468-1475.
| Files | ||
| Issue | Vol 59, No 11 (2021) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v59i11.7777 | |
| Keywords | ||
| Osteoporosis Cost-effectiveness Screening | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Keshavarzi F, Aflaki E, Askarian M, Hatam N. Cost-Effectiveness of Osteoporosis Screening in Women Over 40-Year-Old. Acta Med Iran. 2021;59(11):649-655.
