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Cost-effectiveness of opportunistic QCT-based osteoporosis screening for the prediction of incident vertebral fractures

Objectives: Opportunistic quantitative computed tomography (oQCT) derived from non-dedicated routine CT has demonstrated high accuracy in diagnosing osteoporosis and predicting incident vertebral fractures (VFs). We aimed to investigate the cost-effectiveness of oQCT screening compared to dual-energ...

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Main Authors: Rühling, Sebastian (Author) , Schwarting, Julian (Author) , Froelich, Matthias F. (Author) , Löffler, Maximilian T. (Author) , Bodden, Jannis (Author) , Hernandez Petzsche, Moritz R. (Author) , Baum, Thomas (Author) , Wostrack, Maria (Author) , Aftahy, A. Kaywan (Author) , Seifert-Klauss, Vanadin (Author) , Sollmann, Nico (Author) , Zimmer, Claus (Author) , Kirschke, Jan (Author) , Tollens, Fabian (Author)
Format: Article (Journal)
Language:English
Published: 31 July 2023
In: Frontiers in endocrinology
Year: 2023, Volume: 14, Pages: 1-11
ISSN:1664-2392
DOI:10.3389/fendo.2023.1222041
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.3389/fendo.2023.1222041
Verlag, lizenzpflichtig, Volltext: https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1222041/full
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Author Notes:Sebastian Rühling, Julian Schwarting, Matthias F. Froelich, Maximilian T. Löffler, Jannis Bodden, Moritz R. Hernandez Petzsche, Thomas Baum, Maria Wostrack, A. Kaywan Aftahy, Vanadin Seifert-Klauss, Nico Sollmann, Claus Zimmer, Jan S. Kirschke and Fabian Tollens
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Summary:Objectives: Opportunistic quantitative computed tomography (oQCT) derived from non-dedicated routine CT has demonstrated high accuracy in diagnosing osteoporosis and predicting incident vertebral fractures (VFs). We aimed to investigate the cost-effectiveness of oQCT screening compared to dual-energy X-ray absorptiometry (DXA) as the standard of care for osteoporosis screening. Methods: Three screening strategies (“no osteoporosis screening”, “oQCT screening”, and “DXA screening”) after routine CT were simulated in a state-transition model for hypothetical cohorts of 1,000 patients (women and men aged 65 years) over a follow-up period of 5 years (base case). The primary outcomes were the cumulative costs and the quality-adjusted life years (QALYs) estimated from a U.S. health care perspective for the year 2022. Cost-effectiveness was assessed based on a willingness-to-pay (WTP) threshold of $70,249 per QALY. The secondary outcome was the number of prevented VFs. Deterministic and probabilistic sensitivity analyses were conducted to test the models’ robustness. Results: Compared to DXA screening, oQCT screening increased QALYs in both sexes (additional 2.40 per 1,000 women and 1.44 per 1,000 men) and resulted in total costs of $3,199,016 and $950,359 vs. $3,262,934 and $933,077 for women and men, respectively. As a secondary outcome, oQCT screening prevented 2.6 and 2.0 additional VFs per 1,000 women and men, respectively. In the probabilistic sensitivity analysis, oQCT screening remained cost-effective in 88.3% (women) and 90.0% (men) of iterations. Conclusion: oQCT screening is a cost-effective ancillary approach for osteoporosis screening and has the potential to prevent a substantial number of VFs if considered in daily clinical practice.
Item Description:Gesehen am 15.07.2024
Physical Description:Online Resource
ISSN:1664-2392
DOI:10.3389/fendo.2023.1222041

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