The cost-effectiveness of screening in the community to reduce osteoporotic fractures in older women in the UK: Economic evaluation of the SCOOP Study

David A. Turner, Rebekah Fong Soe Khioe, Lee Shepstone, Elizabeth Lenaghan, Cyrus Cooper, Neil Gittoes, Nicholas C Harvey, Richard Holland, Amanda Howe, Eugene V. McCloskey, Terrence O'Neil, David Torgerson, Richard Fordham, SCOOP Study Team

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Abstract

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. We 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. We also 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. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)845-851
Number of pages7
JournalJournal of Bone and Mineral Research
Volume33
Issue number5
Early online date22 Feb 2018
DOIs
Publication statusPublished - May 2018

Keywords

  • Health Economics
  • DXA
  • screening
  • osteoporosis
  • fracture prevention

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