Schousboe John T, Ensrud Kristine E, Nyman John A, Kane Robert L, Melton L Joseph
Park Nicollet Health Services, Minneapolis, MN, USA.
Osteoporos Int. 2005 Dec;16(12):1883-93. doi: 10.1007/s00198-005-1956-7. Epub 2005 Aug 31.
Prevalent vertebral deformities are predictive of future clinical fractures independent of bone density. We used a Markov model with eight health states to estimate from the societal perspective the cost-effectiveness of using spine radiographs to identify postmenopausal women age 60 or older with one or more vertebral deformities and then treat them with anti-resorptive drug therapy to prevent fractures. We compared three strategies: 5 years of amino-bisphosphonate (alendronate) therapy for all, 5 years of alendronate therapy for only those with prevalent a radiographic vertebral deformity or no initial alendronate treatment. Lifetime direct medical and indirect costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were tracked. For women with one or more prevalent vertebral deformities, the costs per QALY gained ranged from 5,084 dollars (for an 80 year old with a T-score of -2.4) to 61,192 dollars (for a 60 year old with a T-score of -1.0). For women without prevalent vertebral deformity, the costs per QALY gained ranged from 41,897 dollars (for a 60 year old with a T-score of -2.4) to 166,219 dollars (for an 80 year old with a T-score of -1.0). These results were modestly sensitive to reasonable changes in fracture rates, disutility, discount rates and assumptions about the accuracy of spinal radiographs for detecting vertebral deformity. Assuming a societal willingness to pay per QALY gained of 50,000 dollars, the strategy of performing spine radiographs in post-menopausal osteopenic women with T-scores at or below -1.5 and treating those with 1 or more prevalent vertebral deformities is likely to be cost-effective. However, further research on the accuracy of vertebral deformity ascertainment from routine clinical radiographs and on the efficacy of amino-bisphosphonate drugs for reducing the risk of non-vertebral fractures in osteopenic women is needed to define more precisely the subset of osteopenic post-menopausal women in whom use of spinal radiographs is most cost-effective.
普遍存在的椎体畸形可独立于骨密度预测未来的临床骨折。我们使用了一个具有八种健康状态的马尔可夫模型，从社会角度评估利用脊柱X光片识别60岁及以上有一处或多处椎体畸形的绝经后女性，然后用抗吸收药物治疗以预防骨折的成本效益。我们比较了三种策略：对所有人进行5年的氨基双膦酸盐（阿仑膦酸盐）治疗、仅对有明显椎体畸形的人进行5年的阿仑膦酸盐治疗或不进行初始阿仑膦酸盐治疗。跟踪了终身直接医疗和间接成本、质量调整生命年（QALY）和增量成本效益比（ICER）。对于有一处或多处明显椎体畸形的女性，每获得一个QALY的成本从5084美元（对于一名80岁、T值为-2.4的女性）到61192美元（对于一名60岁、T值为-1.0 的女性）不等。对于没有明显椎体畸形的女性，每获得一个QALY的成本从41897美元（对于一名60岁、T值为-2.4的女性）到166219美元（对于一名80岁、T值为-1.0的女性）不等。这些结果对骨折率、失用性、贴现率以及关于脊柱X光片检测椎体畸形准确性的假设的合理变化有适度的敏感性。假设社会愿意为每个获得的QALY支付50000美元，对T值在-1.5及以下的绝经后骨质减少女性进行脊柱X光检查并治疗有一处或多处明显椎体畸形的女性的策略可能具有成本效益。然而，需要进一步研究从常规临床X光片确定椎体畸形的准确性以及氨基双膦酸盐药物降低骨质减少女性非椎体骨折风险的疗效，以更精确地确定使用脊柱X光片最具成本效益的骨质减少绝经后女性亚组。
