A recent Journal of Bone and Mineral Research analysis indicates that screening for fracture risk in older postmenopausal women is a good use of healthcare resources—in other words, it's cost-effective. The current study aims to use resource-use and outcome data collected as part of the SCOOP study to estimate the cost-effectiveness of the SCOOP screening intervention over a 5-year time horizon.
The analysis examined results from a large randomized controlled trial. Screening, using the FRAX fracture risk calculator in addition to bone density measurements, was highly cost-effective when compared with usual management, with savings due to prevention of all osteoporosis-related fractures and hip fractures.
The SCOOP study was a two-arm randomized controlled trial conducted in the UK in 12,483 eligible women aged 70 to 85 years. It compared a screening program using the FRAX® risk assessment tool in addition to bone mineral density (BMD) measures versus usual management.
The SCOOP study found a reduction in the incidence of hip fractures in the screening arm, but there was no evidence of a reduction in the incidence of all osteoporosis-related fractures.
To make decisions about whether to implement any screening program, we should also consider whether the program is likely to be a good use of health care resources, ie, is it cost-effective? The cost per gained quality adjusted life year of screening for fracture risk has not previously been demonstrated in an economic evaluation alongside a clinical trial.
Researcehrs conducted a “within trial” economic analysis alongside the SCOOP study from the perspective of a national health payer, the UK National Health Service (NHS). The main outcome measure in the economic analysis was the cost per quality adjusted life year (QALY) gained over a 5-year time period.
They estimated cost per osteoporosis-related fracture prevented and the cost per hip fracture prevented. The screening arm had an average incremental QALY gain of 0.0237 (95% confidence interval –0.0034 to 0.0508) for the 5-year follow-up. The incremental cost per QALY gained was £2772 compared with the control arm.
Cost-effectiveness acceptability curves indicated a 93% probability of the intervention being cost-effective at values of a QALY greater than £20,000. The intervention arm prevented fractures at a cost of £4478 and £7694 per fracture for osteoporosis-related and hip fractures, respectively.
The current study demonstrates that a systematic, community-based screening program of fracture risk in older women in the UK represents a highly cost-effective intervention.
The SCOOP clinical trial demonstrated that community screening, based upon the FRAX probability of hip fracture, leads to a significant reduction in hip fractures in older women. The current study provides strong evidence that community screening, based upon the FRAX probability of hip fracture in older women, would likely be cost-effective and represent an efficient use of health care resources.