It may be cost-effective to screen and treat selected older men with osteoporosis, depending on their age and if they have had a prior fracture, according to a study in the August 8 issue of JAMA.
Osteoporotic fractures are recognized as a common and serious health problem among elderly men, with white men at age 60 years having a 29 percent chance of experiencing such a fracture during their remaining lifetime, according to background information in the article. One-third of all hip fractures occur in men and are associated with as much illness and increased risk of death than those that occur in women. Despite the importance of the problem of osteoporosis in men, there is a lack of evidence regarding the cost-effectiveness of common diagnostic and therapeutic interventions.
John T. Schousboe, M.D., M.S., of Park Nicollet Health Services, Minneapolis, and colleagues conducted a study to estimate the lifetime costs and health benefits of bone densitometry (measurement of bone density) followed by 5 years of oral bisphosphonate (a class of drugs used to strengthen bone) therapy for men found to have osteoporosis. The researchers created a computer simulation model for hypothetical groups of white men age 65, 70, 75, 80, or 85 years, with or without prior clinical fracture. Data from several sources were used to estimate fracture costs and population-based age-specific fracture rates and associations among prior fractures, bone density and incident fractures. The authors estimated the costs per quality-adjusted life-years (QALYs) gained for the densitometry and follow-up treatment strategy compared with no intervention, calculated from lifetime costs and accumulated QALYs for each strategy.
The researchers found that the estimated prevalence of femoral neck osteoporosis among men with a prior fracture ranged from 14.5 percent at age 65 years to 33.6 percent at age 85 years. Osteoporosis prevalence in the absence of a prior clinical fracture was lower, ranging from 7.6 percent at age 65 years to 17.6 percent at age 85 years. The densitometry and treatment strategy modestly reduced the absolute 10-year incidence of clinical fractures by a range of 2.1 percent for 65-year-old men without a prior fracture to 4.5 percent among 85-year-old men with a prior fracture.
Regarding cost-effectiveness, "universal bone densitometry followed by oral bisphosphonate therapy among those found to have osteoporosis for all men aged 70 years or older regardless of fracture history or other fracture risk factors is not cost-effective using current drug costs. However, this strategy may be cost-effective for men aged 65 years or older with a prior clinical fracture and for men aged 80 years or older without a prior fracture, assuming a societal willingness to pay per QALY gained of $50,000. This densitometry and treatment strategy may also be cost-effective for white men aged 70 years or older without a prior clinical fracture if the cost of oral bisphosphonate therapy is less than $500 per year or if the societal willingness to pay per QALY gained is $100,000."
(JAMA. 2007;298(6):629-637. Available pre-embargo to the media at www.jamamedia.org)
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