Park Nicollet Institute, Minneapolis, MN, USA.
Osteoporos Int. 2013 Jan;24(1):163-77. doi: 10.1007/s00198-012-1936-7. Epub 2012 Feb 17.
We used a microsimulation model to estimate the threshold body weights at which screening bone densitometry is cost-effective. Among women aged 55-65 years and men aged 55-75 years without a prior fracture, body weight can be used to identify those for whom bone densitometry is cost-effective.
Bone densitometry may be more cost-effective for those with lower body weight since the prevalence of osteoporosis is higher for those with low body weight. Our purpose was to estimate weight thresholds below which bone densitometry is cost-effective for women and men without a prior clinical fracture at ages 55, 60, 65, 75, and 80 years.
We used a microsimulation model to estimate the costs and health benefits of bone densitometry and 5 years of fracture prevention therapy for those without prior fracture but with femoral neck osteoporosis (T-score ≤ -2.5) and a 10-year hip fracture risk of ≥3%. Threshold pre-test probabilities of low BMD warranting drug therapy at which bone densitometry is cost-effective were calculated. Corresponding body weight thresholds were estimated using data from the Study of Osteoporotic Fractures (SOF), the Osteoporotic Fractures in Men (MrOS) study, and the National Health and Nutrition Examination Survey (NHANES) for 2005-2006.
Assuming a willingness to pay of $75,000 per quality adjusted life year (QALY) and drug cost of $500/year, body weight thresholds below which bone densitometry is cost-effective for those without a prior fracture were 74, 90, and 100 kg, respectively, for women aged 55, 65, and 80 years; and were 67, 101, and 108 kg, respectively, for men aged 55, 75, and 80 years.
For women aged 55-65 years and men aged 55-75 years without a prior fracture, body weight can be used to select those for whom bone densitometry is cost-effective.
我们使用微观模拟模型来估算进行骨密度筛查具有成本效益的体重阈值。在无既往骨折的 55-65 岁女性和 55-75 岁男性中，体重可用于确定骨密度检查具有成本效益的人群。
对于体重较低的人群，骨密度检查可能更具成本效益，因为体重较低的人群骨质疏松症的患病率更高。我们的目的是估算在无既往临床骨折的情况下，55、60、65、75 和 80 岁女性和男性的骨密度检查具有成本效益的体重阈值。
我们使用微观模拟模型来估算无既往骨折但股骨颈骨质疏松症（T 评分≤-2.5）且 10 年髋部骨折风险≥3%的人群进行骨密度检查和 5 年骨折预防治疗的成本和健康获益。计算出需要药物治疗的低骨密度的预检测概率阈值，以确保骨密度检查具有成本效益。使用来自骨质疏松性骨折研究（SOF）、男性骨质疏松症研究（MrOS）和 2005-2006 年国家健康和营养调查（NHANES）的数据来估算相应的体重阈值。
假设愿意为每增加一个质量调整生命年（QALY）支付 75000 美元，且药物成本为每年 500 美元，则对于无既往骨折的人群，55、65 和 80 岁女性的骨密度检查具有成本效益的体重阈值分别为 74、90 和 100 公斤；55、75 和 80 岁男性的骨密度检查具有成本效益的体重阈值分别为 67、101 和 108 公斤。
对于无既往骨折的 55-65 岁女性和 55-75 岁男性，可以使用体重来选择骨密度检查具有成本效益的人群。
