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Osteoporosis International

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01-07-2016 | Original Article

Screening for osteoporosis in Chinese post-menopausal women: a health economic modelling study

Authors: L. Si, T. M. Winzenberg, M. Chen, Q. Jiang, A. Neil, A. J. Palmer

Published in: Osteoporosis International | Issue 7/2016

Abstract

Summary

Screening and appropriate treatment for osteoporosis has been proven to be cost-effective in many populations; however, it is not clear in the Chinese population. Simulations using a validated health economics model suggest that screening for osteoporosis in Chinese women is cost-effective and may even be cost-saving in Chinese post-menopausal women.

Introduction

This study aimed at determining the cost-effectiveness of osteoporosis screening strategies in post-menopausal Chinese women.

Methods

A validated state-transition microsimulation model with a lifetime horizon was used to evaluate the cost-effectiveness of different screening strategies with treatment of alendronate compared with current osteoporosis management in China. Osteoporosis screening strategies assessed were (1) universal screening with dual-energy X-ray absorptiometry (DXA) alone; (2) Osteoporosis Self-Assessment Tool for Asians (OSTA) + DXA; and (3) quantitative ultrasound (QUS) + DXA with rescreening at 2, 5 or 10-year intervals for patients screened negative by DXA. The study was performed from the Chinese healthcare payer’s perspective. All model inputs were retrieved from publically available literature. Uncertainties were addressed by one-way and probabilistic sensitivity analysis.

Results

Screening strategies all improved clinical outcomes at increased costs, and each were cost-effective compared with no screening in women aged 55 years given the Chinese willingness-to-pay threshold of USD 20,000 per quality-adjusted life year (QALY) gained. Pre-screening with QUS and subsequent DXA screening if the QUS T-score ≤ −0.5 with a 2-year rescreening interval was the most cost-effective strategy with the highest probability of being cost-effective across all non-dominated strategies. Screening strategies were cost-saving if screenings were initiated from age 65 years. One-way sensitivity analyses indicated that the results were robust.

Conclusions

Pre-screening with QUS with subsequent DXA screening if the QUS T-score ≤ −0.5 with a 2-year rescreening interval in the Chinese women starting at age 55 is the most cost-effective. In addition, screening and treatment strategies are cost-saving if the screening initiation age is greater than 65 years.

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Wang Y, Tao Y, Hyman ME, Li J, Chen Y (2009) Osteoporosis in china. Osteoporos Int 20:1651–1662CrossRefPubMed

Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521CrossRefPubMed

Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936CrossRefPubMed

Si L, Winzenberg TM, de Graaff B, Palmer AJ (2014) A systematic review and meta-analysis of utility-based quality of life for osteoporosis-related conditions. Osteoporos Int 25:1987–1997CrossRefPubMed

Si L, Winzenberg TM, Chen M, Jiang Q, Palmer AJ (2015) Residual lifetime and 10 year absolute risks of osteoporotic fractures in Chinese men and women. Curr Med Res Opin 31:1149–1156CrossRefPubMed

Si L, Winzenberg TM, Jiang Q, Chen M, Palmer AJ (2015) Projection of osteoporosis-related fractures and costs in China: 2010–2050. Osteoporos Int 26:1929–1937CrossRefPubMed

Mithal A, Ebeling P, Kyer CS (2013) Asia-Pacific regional audit: epidemiology, costs & burden of osteoporosis in 2013. International Osteoporosis Foundation, Nyon

Guo P, Wang S, Zhu Y, Shen X, Jin X, Qian M, Tang H (2012) Prevalence of osteopenia and osteoporosis and factors associated with decreased bone mineral density in elderly inpatients with psychiatric disorders in Huzhou, China. Shanghai Arch Psychiatry 24:262–270PubMedPubMedCentral

Si L, Winzenberg TM, Palmer AJ (2014) A systematic review of models used in cost-effectiveness analyses of preventing osteoporotic fractures. Osteoporos Int 25:51–60CrossRefPubMed

10.

Schwenkglenks M, Lippuner K (2007) Simulation-based cost-utility analysis of population screening-based alendronate use in Switzerland. Osteoporos Int 18:1481–1491CrossRefPubMed

11.

Mueller D, Gandjour A (2008) Cost effectiveness of ultrasound and bone densitometry for osteoporosis screening in post-menopausal women. Appl Health Econ Health Policy 6:113–135CrossRefPubMed

12.

Nayak S, Roberts MS, Greenspan SL (2011) Cost-effectiveness of different screening strategies for osteoporosis in postmenopausal women. Ann Intern Med 155:751–761CrossRefPubMedPubMedCentral

13.

Kingkaew P, Maleewong U, Ngarmukos C, Teerawattananon Y (2012) Evidence to inform decision makers in Thailand: a cost-effectiveness analysis of screening and treatment strategies for postmenopausal osteoporosis. Value Health 15:S20–28CrossRefPubMed

14.

Drummond M, Barbieri M, Cook J, Glick HA, Lis J, Malik F, Reed SD, Rutten F, Sculpher M, Severens J (2009) Transferability of economic evaluations across jurisdictions: ISPOR Good Research Practices Task Force report. Value Health 12:409–418CrossRefPubMed

15.

Chinese Medical Association (2011) Guidelines for the prevention and treatment of primary osteoporosis [in Chinese]. Chin J Osteoporos Bone Miner Res 4:2–17

16.

Si L, Winzenberg TM, Jiang Q, Palmer AJ (2015) Screening for and treatment of osteoporosis: construction and validation of a state-transition microsimulation cost-effectiveness model. Osteoporos Int 26:1477–1489CrossRefPubMed

17.

Mithal A, Dhingra V, Lau E (2009) The Asian Audit Epidemiology, costs and burden of osteoporosis in Asia 2009. International Osteoporosis Foundation, Switzerland

18.

China Center for Health Economic Research (2011) China guidelines for pharmacoeconomic evaluations. Beijing

19.

Qu B, Ma Y, Yan M, Wu HH, Fan L, Liao DF, Pan XM, Hong Z (2014) The economic burden of fracture patients with osteoporosis in western China. Osteoporos Int 25:1853–1860CrossRefPubMed

20.

Zhang ZQ, Ho SC, Chen ZQ, Zhang CX, Chen YM (2014) Reference values of bone mineral density and prevalence of osteoporosis in Chinese adults. Osteoporos Int 25:497–507CrossRefPubMed

21.

Wang J, Wang Y, Liu WD, Wang F, Yin ZS (2014) Hip fractures in Hefei, China: the Hefei osteoporosis project. J Bone Miner Metab 32:206–214CrossRefPubMed

22.

Bow CH, Cheung E, Cheung CL et al (2012) Ethnic difference of clinical vertebral fracture risk. Osteoporos Int 23:879–885CrossRefPubMed

23.

Lofthus CM, Frihagen F, Meyer HE, Nordsletten L, Melhuus K, Falch JA (2008) Epidemiology of distal forearm fractures in Oslo, Norway. Osteoporos Int 19:781–786CrossRefPubMed

24.

Ministry of Health (2012) China Public Health Statistical Yearbook. Peking Union Medical College Publishing House, Beijing

25.

Melton LJ 3rd, Thamer M, Ray NF, Chan JK, Chesnut CH 3rd, Einhorn TA, Johnston CC, Raisz LG, Silverman SL, Siris ES (1997) Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res 12:16–23CrossRefPubMed

26.

Black DM, Cummings SR, Karpf DB et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541CrossRefPubMed

27.

Cummings SR, Black DM, Thompson DE et al (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280:2077–2082CrossRefPubMed

28.

Cranney A, Tugwell P, Zytaruk N, Robinson V, Weaver B, Shea B, Wells G, Adachi J, Waldegger L, Guyatt G (2002) Meta-analyses of therapies for postmenopausal osteoporosis. VI. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis. Endocr Rev 23:540–551CrossRefPubMed

29.

Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA (2011) Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 155:827–838CrossRefPubMed

30.

Cheng T-T, Yu S-F, Hsu C-Y, Chen S-H, Su BY-J, Yang T-S (2013) Differences in adherence to osteoporosis regimens: a 2-year analysis of a population treated under specific guidelines. Clin Ther 35:1005–1015CrossRefPubMed

31.

Giusti A, Barone A, Razzano M, Oliveri M, Pizzonia M, Palummeri E, Pioli G (2009) Persistence with calcium and vitamin D in elderly patients after hip fracture. J Bone Miner Metab 27:95–100CrossRefPubMed

32.

Jackson RD, LaCroix AZ, Gass M et al (2006) Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 354:669–683CrossRefPubMed

33.

Yang Y, Wang B, Fei Q, Meng Q, Li D, Tang H, Li J, Su N (2013) Validation of an osteoporosis self-assessment tool to identify primary osteoporosis and new osteoporotic vertebral fractures in postmenopausal Chinese women in Beijing. BMC Musculoskelet Disord 14:271CrossRefPubMedPubMedCentral

34.

Nayak S, Olkin I, Liu H, Grabe M, Gould MK, Allen IE, Owens DK, Bravata DM (2006) Meta-analysis: accuracy of quantitative ultrasound for identifying patients with osteoporosis. Ann Intern Med 144:832–841CrossRefPubMed

35.

Medicine price platform, Jiangsu Province. Bureau of Commodity Prices, Jiangsu Province. http://yy.jspn.net/ Accessed July 4th 2014

36.

Sun S, Chen J, Johannesson M, Kind P, Xu L, Zhang Y, Burstrom K (2011) Population health status in China: EQ-5D results, by age, sex and socio-economic status, from the National Health Services Survey 2008. Qual Life Res 20:309–320CrossRefPubMed

37.

Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK (2008) Medication compliance and persistence: terminology and definitions. Value Health 11:44–47CrossRefPubMed

38.

Hiligsmann M, Boonen A, Rabenda V, Reginster JY (2012) The importance of integrating medication adherence into pharmacoeconomic analyses: the example of osteoporosis. Expert Rev Pharmacoecon Outcomes Res 12:159–166CrossRefPubMed

39.

Hiligsmann M, Rabenda V, Bruyère O, Reginster J-Y (2010) The clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients. Health Policy 96:170–177CrossRefPubMed

40.

Briggs AH, Weinstein MC, Fenwick EA, Karnon J, Sculpher MJ, Paltiel AD (2012) Model parameter estimation and uncertainty: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force—6. Value Health 15:835–842CrossRefPubMed

41.

Briggs AH, Gray AM (1999) Handling uncertainty when performing economic evaluation of healthcare interventions. Health Technol Assess 3:1–134PubMed

42.

Gray AM, Clarke PM, Wolstenholme JL, Wordsworth S (2010) Applied methods of cost-effectiveness analysis in healthcare. Oxford University Press

43.

Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E (2013) Consolidated Health Economic Evaluation Reporting Standards (CHEERS)—explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health 16:231–250CrossRefPubMed

44.

Mueller D, Weyler E, Gandjour A (2008) Cost effectiveness of the German screen-and-treat strategy for postmenopausal osteoporosis. Pharmacoeconomics 26:513–536CrossRefPubMed

45.

Nagata-Kobayashi S, Shimbo T, Fukui T (2002) Cost-effectiveness analysis of screening for osteoporosis in postmenopausal Japanese women. J Bone Miner Metab 20:350–357CrossRefPubMed

46.

Compston J (2015) Overdiagnosis of osteoporosis: fact or fallacy? Osteoporos Int 26:2051–2054CrossRefPubMed

47.

Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui L-Y, Ransohoff DF, Cauley JA, Ensrud KE (2012) Bone-density testing interval and transition to osteoporosis in older women. N Engl J Med 366:225–233CrossRefPubMedPubMedCentral

48.

Hiligsmann M, Gathon HJ, Bruyere O, Ethgen O, Rabenda V, Reginster JY (2010) Cost-effectiveness of osteoporosis screening followed by treatment: the impact of medication adherence. Value Health 13:394–401CrossRefPubMed

49.

Compston J, Cooper A, Cooper C, Francis R, Kanis JA, Marsh D, McCloskey EV, Reid DM, Selby P, Wilkins M (2009) Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas 62:105–108CrossRefPubMed

50.

Qaseem A, Snow V, Shekelle P, Hopkins JR, Forciea MA, Owens DK (2008) Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the american college of physicians. Ann Intern Med 149:404–415CrossRefPubMed

51.

Hagen G, Wisløff T, Falch J, Lofthus C, Frihagen F, Wensaas K-A, Granum L, Nevjar J, Kristiansen I (2011) Efficacy and cost-effectiveness of alendronate for the prevention of fractures in postmenopausal women in Norway. Norwegian Knowledge Centre for the Health Services

52.

Chen XF, Li XL, Zhang H, Liu GJ (2014) Were you identified to be at high fracture risk by FRAX(R) before your osteoporotic fracture occurred? Clin Rheumatol 33:693–698CrossRefPubMed

Title: Screening for osteoporosis in Chinese post-menopausal women: a health economic modelling study
Authors: L. Si
T. M. Winzenberg
M. Chen
Q. Jiang
A. Neil
A. J. Palmer
Publication date: 01-07-2016
Publisher: Springer London
Published in: Osteoporosis International / Issue 7/2016
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-016-3502-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Screening for osteoporosis in Chinese post-menopausal women: a health economic modelling study

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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