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01-08-2020 | Care | Original Article

Long-term cost-effectiveness of screening for fracture risk in a UK primary care setting: the SCOOP study

Authors: E. Söreskog, F. Borgström, L. Shepstone, S. Clarke, C. Cooper, I. Harvey, N. C. Harvey, A. Howe, H. Johansson, T. Marshall, T. W. O’Neill, T. J. Peters, N. M. Redmond, D. Turner, R. Holland, E. McCloskey, J. A. Kanis, SCOOP study team

Published in: Osteoporosis International | Issue 8/2020

Abstract

Summary

Community-based screening and treatment of women aged 70–85 years at high fracture risk reduced fractures; moreover, the screening programme was cost-saving. The results support a case for a screening programme of fracture risk in older women in the UK.

Introduction

The SCOOP (screening for prevention of fractures in older women) randomized controlled trial investigated whether community-based screening could reduce fractures in women aged 70–85 years. The objective of this study was to estimate the long-term cost-effectiveness of screening for fracture risk in a UK primary care setting compared with usual management, based on the SCOOP study.

Methods

A health economic Markov model was used to predict the life-time consequences in terms of costs and quality of life of the screening programme compared with the control arm. The model was populated with costs related to drugs, administration and screening intervention derived from the SCOOP study. Fracture risk reduction in the screening arm compared with the usual management arm was derived from SCOOP. Modelled fracture risk corresponded to the risk observed in SCOOP.

Results

Screening of 1000 patients saved 9 hip fractures and 20 non-hip fractures over the remaining lifetime (mean 14 years) compared with usual management. In total, the screening arm saved costs (£286) and gained 0.015 QALYs/patient in comparison with usual management arm.

Conclusions

This analysis suggests that a screening programme of fracture risk in older women in the UK would gain quality of life and life years, and reduce fracture costs to more than offset the cost of running the programme.

Svedbom A, Hernlund E, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA, IOF, EURPo (2013) Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 8:137. https://doi.org/10.1007/s11657-013-0137-0 CrossRefPubMedPubMedCentral

Kanis JA, Cooper C, Rizzoli R, Reginster JY, on behalf of the Scientific Advisory Board of the European Society for, C, Economic Aspects of, O, the Committees of Scientific, A, and National Societies of the International Osteoporosis, F (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30(1):3–44. https://doi.org/10.1007/s00198-018-4704-5 CrossRefPubMed

Kanis JA, Borgstrom F, Compston J, Dreinhofer K, Nolte E, Jonsson L, Lems WF, McCloskey EV, Rizzoli R, Stenmark J (2013) SCOPE: a scorecard for osteoporosis in Europe. Arch Osteoporos 8:144. https://doi.org/10.1007/s11657-013-0144-1 CrossRefPubMedPubMedCentral

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19(4):385–397. https://doi.org/10.1007/s00198-007-0543-5 CrossRefPubMedPubMedCentral

Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Gluer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ 3rd, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18(8):1033–1046. https://doi.org/10.1007/s00198-007-0343-y CrossRefPubMed

National Institute for Health and Care Excellence (NICE) (2017) NICE clinical guideline 146. Osteoporosis: assessing the risk of fragility fracture. https://www.nice.org.uk/guidance/cg146. Accessed 15 Mar 2020

Compston J, Cooper A, Cooper C, Gittoes N, Gregson C, Harvey N, Hope S, Kanis JA, McCloskey EV, Poole KES, Reid DM, Selby P, Thompson F, Thurston A, Vine N, National Osteoporosis Guideline G (2017) UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 12(1):43. https://doi.org/10.1007/s11657-017-0324-5 CrossRefPubMedPubMedCentral

Shepstone L, Lenaghan E, Cooper C, Clarke S, Fong-Soe-Khioe R, Fordham R, Gittoes N, Harvey I, Harvey N, Heawood A, Holland R, Howe A, Kanis J, Marshall T, O'Neill T, Peters T, Redmond N, Torgerson D, Turner D, McCloskey E, Team SS (2018) Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet 391(10122):741–747. https://doi.org/10.1016/S0140-6736(17)32640-5 CrossRefPubMed

Turner DA, Khioe RFS, Shepstone L, Lenaghan E, Cooper C, Gittoes N, Harvey NC, Holland R, Howe A, McCloskey E, O'Neill TW, Torgerson D, Fordham R, Scoop Study Team (2018) The cost-effectiveness of screening in the community to reduce osteoporotic fractures in older women in the UK: economic evaluation of the SCOOP study. J Bone Miner Res 33(5):845–851. https://doi.org/10.1002/jbmr.3381 CrossRefPubMed

10.

Strom O, Borgstrom F, Sen SS, Boonen S, Haentjens P, Johnell O, Kanis JA (2007) Cost-effectiveness of alendronate in the treatment of postmenopausal women in 9 European countries--an economic evaluation based on the fracture intervention trial. Osteoporos Int 18(8):1047–1061. https://doi.org/10.1007/s00198-007-0349-5 CrossRefPubMed

11.

Borgstrom F, Jonsson B, Strom O, Kanis JA (2006) An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting: based on the results of the SOTI and TROPOS trials. Osteoporos Int 17(12):1781–1793. https://doi.org/10.1007/s00198-006-0193-z CrossRefPubMed

12.

Jonsson B, Strom O, Eisman JA, Papaioannou A, Siris ES, Tosteson A, Kanis JA (2011) Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis. Osteoporos Int 22(3):967–982. https://doi.org/10.1007/s00198-010-1424-x CrossRefPubMed

13.

Gutierrez L, Roskell N, Castellsague J, Beard S, Rycroft C, Abeysinghe S, Shannon P, Gitlin M, Robbins S (2012) Clinical burden and incremental cost of fractures in postmenopausal women in the United Kingdom. Bone 51(3):324–331. https://doi.org/10.1016/j.bone.2012.05.020 CrossRefPubMed

14.

Gutierrez L, Roskell N, Castellsague J, Beard S, Rycroft C, Abeysinghe S, Shannon P, Robbins S, Gitlin M (2011) Study of the incremental cost and clinical burden of hip fractures in postmenopausal women in the United Kingdom. J Med Econ 14(1):99–107. https://doi.org/10.3111/13696998.2010.547967 CrossRefPubMed

15.

Szende A, Janssen B, Cabases J (2014) Self-Reported Population Health: An International Perspective based on EQ-5D. Springer, NetherlandsCrossRef

16.

Kanis JA, Johansson H, Oden A, Harvey NC, Gudnason V, Sanders KM, Sigurdsson G, Siggeirsdottir K, Fitzpatrick LA, Borgstrom F, McCloskey EV (2018) Characteristics of recurrent fractures. Osteoporos Int 29(8):1747–1757. https://doi.org/10.1007/s00198-018-4502-0 CrossRefPubMedPubMedCentral

17.

Dataset: National life tables: Great Britain (2014–2016). Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/datasets/nationallifetablesgreatbritainreferencetables. Accessed 15 Mar 2020

18.

Parker MJ, Anand JK (1991) What is the true mortality of hip fractures? Public Health 105(6):443–446CrossRefPubMed

19.

Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32(5):468–473CrossRefPubMed

20.

National Institute for Health and Care Excellence (NICE) Guide to the methods of technology appraisal 2013: https://www.nice.org.uk/process/pmg9/chapter/foreword. Accessed 15 Mar 2020

21.

Abrahamsen B, Eiken P, Prieto-Alhambra D, Eastell R (2016) Risk of hip, subtrochanteric, and femoral shaft fractures among mid and long term users of alendronate: nationwide cohort and nested case-control study. BMJ 353:i3365. https://doi.org/10.1136/bmj.i3365 CrossRefPubMedPubMedCentral

22.

Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, Satterfield S, Wallace RB, Bauer DC, Palermo L, Wehren LE, Lombardi A, Santora AC, Cummings SR, Group, FR (2006) Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 296(24):2927–2938. https://doi.org/10.1001/jama.296.24.2927 CrossRefPubMed

23.

Ensrud KE, Barrett-Connor EL, Schwartz A, Santora AC, Bauer DC, Suryawanshi S, Feldstein A, Haskell WL, Hochberg MC, Torner JC, Lombardi A, Black DM, Fracture Intervention Trial Long-Term Extension Research, G (2004) Randomized trial of effect of alendronate continuation versus discontinuation in women with low BMD: results from the Fracture Intervention Trial long-term extension. J Bone Miner Res 19(8):1259–1269. https://doi.org/10.1359/JBMR.040326 CrossRefPubMed

24.

Adams AL, Adams JL, Raebel MA, Tang BT, Kuntz JL, Vijayadeva V, McGlynn EA, Gozansky WS (2018) Bisphosphonate drug holiday and Fracture risk: a population-based cohort study. J Bone Miner Res 33(7):1252–1259. https://doi.org/10.1002/jbmr.3420 CrossRefPubMed

25.

Adler RA, El-Hajj Fuleihan G, Bauer DC, Camacho PM, Clarke BL, Clines GA, Compston JE, Drake MT, Edwards BJ, Favus MJ, Greenspan SL, McKinney R Jr, Pignolo RJ, Sellmeyer DE (2016) Managing Osteoporosis in patients on Long-Term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 31(1):16–35. https://doi.org/10.1002/jbmr.2708 CrossRefPubMed

26.

McClung M, Harris ST, Miller PD, Bauer DC, Davison KS, Dian L, Hanley DA, Kendler DL, Yuen CK, Lewiecki EM (2013) Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med 126(1):13–20. https://doi.org/10.1016/j.amjmed.2012.06.023 CrossRefPubMed

27.

Curtis JR, Westfall AO, Cheng H, Delzell E, Saag KG (2008) Risk of hip fracture after bisphosphonate discontinuation: implications for a drug holiday. Osteoporos Int 19(11):1613–1620. https://doi.org/10.1007/s00198-008-0604-4 CrossRefPubMedPubMedCentral

28.

Jonsson B, Kanis J, Dawson A, Oden A, Johnell O (1999) Effect and offset of effect of treatments for hip fracture on health outcomes. Osteoporos Int 10(3):193–199. https://doi.org/10.1007/s001980050215 CrossRefPubMed

29.

Edelman D, Olsen MK, Dudley TK, Harris AC, Oddone EZ (2002) Impact of diabetes screening on quality of life. Diabetes Care 25(6):1022–1026. https://doi.org/10.2337/diacare.25.6.1022 CrossRefPubMed

30.

Collins RE, Lopez LM, Marteau TM (2011) Emotional impact of screening: a systematic review and meta-analysis. BMC Public Health 11:603. https://doi.org/10.1186/1471-2458-11-603 CrossRefPubMedPubMedCentral

31.

Torgerson DJ, Thomas RE, Campbell MK, Reid DM (1997) Randomized trial of osteoporosis screening. Use of hormone replacement therapy and quality-of-life results. Arch Intern Med 157(18):2121–2125. https://doi.org/10.1001/archinte.157.18.2121 CrossRefPubMed

32.

Barr RJ, Stewart A, Torgerson DJ, Reid DM (2010) Population screening for osteoporosis risk: a randomised control trial of medication use and fracture risk. Osteoporos Int 21(4):561–568. https://doi.org/10.1007/s00198-009-1007-x CrossRefPubMed

33.

Peto L, Allaby M (2013) Screening for osteoporosis in postmenopausal women. A report for the UK National Screening Committee. of Medium] Last Update [cited Access 2013; Available from: https://legacyscreening.phe.org.uk/policydb_download.php?doc=270

34.

Hoiberg MP, Rubin KH, Holmberg T, Rothmann MJ, Moller S, Gram J, Bech M, Brixen K, Hermann AP (2019) Use of antiosteoporotic medication in the Danish ROSE population-based screening study. Osteoporos Int 30(6):1223–1233. https://doi.org/10.1007/s00198-019-04934-7 CrossRefPubMed

35.

Rubin KH, Rothmann MJ, Holmberg T, Hoiberg M, Moller S, Barkmann R, Gluer CC, Hermann AP, Bech M, Gram J, Brixen K (2018) Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized risk-stratified Osteoporosis strategy evaluation (ROSE) study. Osteoporos Int 29(3):567–578. https://doi.org/10.1007/s00198-017-4326-3 CrossRefPubMed

36.

Rothmann MJ, Moller S, Holmberg T, Hojberg M, Gram J, Bech M, Brixen K, Hermann AP, Gluer CC, Barkmann R, Rubin KH (2017) Non-participation in systematic screening for osteoporosis-the ROSE trial. Osteoporos Int 28(12):3389–3399. https://doi.org/10.1007/s00198-017-4205-y CrossRefPubMed

37.

Muller D, Pulm J, Gandjour A (2012) Cost-effectiveness of different strategies for selecting and treating individuals at increased risk of osteoporosis or osteopenia: a systematic review. Value Health 15(2):284–298. https://doi.org/10.1016/j.jval.2011.11.030 CrossRefPubMed

Title: Long-term cost-effectiveness of screening for fracture risk in a UK primary care setting: the SCOOP study
Authors: E. Söreskog
F. Borgström
L. Shepstone
S. Clarke
C. Cooper
I. Harvey
N. C. Harvey
A. Howe
H. Johansson
T. Marshall
T. W. O’Neill
T. J. Peters
N. M. Redmond
D. Turner
R. Holland
E. McCloskey
J. A. Kanis
SCOOP study team
Publication date: 01-08-2020
Publisher: Springer London
Keywords: Care
Osteoporosis
Osteoporosis
Published in: Osteoporosis International / Issue 8/2020
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-020-05372-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-term cost-effectiveness of screening for fracture risk in a UK primary care setting: the SCOOP study

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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