Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Osteoporos Int. 2018 Aug;29(8):1793-1805. doi: 10.1007/s00198-018-4543-4. Epub 2018 May 17.
Despite the high costs of hip fracture, many governments provide limited support for osteoporosis screening. We demonstrated that osteoporosis screening by dual-energy X-ray absorptiometry (DXA) with or without pre-screening by Fracture Risk Assessment Tool (FRAX) or calcaneal ultrasound are more cost-effective than no screening in Chinese people aged 65 or over in Hong Kong.
To examine the cost-effective potential osteoporosis screening strategies for hip fracture prevention in Hong Kong.
Decision tree models were constructed to evaluate the cost per quality-adjusted life years (QALYs) of the different osteoporosis screening strategies followed by subsequent 5-year treatment with alendronate compared to no screening (but treat if a hip fracture occurs). The multiple osteoporosis screening strategies were composed of alternative tests and initiation age groups were evaluated with a 10-year horizon, and treatment were assigned if central dual-energy X-ray absorptiometry (DXA) T-score (at either the hip or spine) is - 2.5 or less. Strategies included DXA for all people and pre-screening with the Fracture Risk Assessment Tool (FRAX) at specific thresholds or by calcaneal quantitative ultrasonography (QUS) before taking DXA examination. All the model inputs were based on the Mr. OS and Ms. OS Hong Kong cohort; data are obtained from the Social Welfare Department or the published literature.
All of the screening strategies, including the universal screening with DXA and the pre-screening with FRAX or QUS before DXA, were consistently more cost-effective than no screening for people aged 65 years old or over. One-way sensitivity analysis with a more optimistic assumption on treatment adherence or inclusion of other major osteoporotic fractures did not change the results materially. Probabilistic sensitivity analyses showed a dominant role of pre-screening with FRAX followed by subsequent osteoporosis drug treatment in people aged 70 years old or over in Hong Kong.
Osteoporosis screening strategies based on DXA with or without pre-screening are more cost-effective compared to no screening for Chinese people aged 65 or over in Hong Kong.
探讨适合香港人群的髋部骨折预防的骨质疏松症筛查的成本效益。
构建决策树模型，评估不同骨质疏松症筛查策略的每质量调整生命年（QALY）成本，随后对所有符合条件的患者进行为期 5 年的阿仑膦酸钠治疗，与不筛查（但发生髋部骨折时治疗）相比。该多骨质疏松症筛查策略包括替代检查，评估不同起始年龄组的 10 年预后，并在中心双能 X 线吸收法（DXA）T 评分（髋部或脊柱）≤-2.5 时开始治疗。策略包括对所有人进行 DXA 检查和 FRAX 特定阈值预筛查或在进行 DXA 检查前进行跟骨定量超声检查（QUS）。所有模型输入均基于 Mr. OS 和 Ms. OS 香港队列；数据来自社会福利署或已发表的文献。
所有筛查策略，包括 DXA 普查和 FRAX 或 QUS 预筛查后行 DXA 检查，对 65 岁及以上人群均优于不筛查。治疗依从性更乐观或纳入其他主要骨质疏松性骨折的单向敏感性分析并未改变结果。概率敏感性分析显示，70 岁及以上人群中，FRAX 预筛查后行骨质疏松症药物治疗的效果更为显著。
基于 DXA 的骨质疏松症筛查策略，无论是否有预筛查，均优于不筛查，可提高香港 65 岁及以上人群的成本效益。
