Reginster Jean-Yves, Silverman Stuart L, Alokail Majed, Al-Daghri Nasser, Hiligsmann Mickael
Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Kingdom of Saudi Arabia.
Cedars-Sinai Medical Center, Los Angeles and the OMC Clinical Research Center, Beverly Hills, CA 90211, United States.
JBMR Plus. 2024 Nov 6;9(1):ziae138. doi: 10.1093/jbmrpl/ziae138. eCollection 2025 Jan.
Radiofrequency echographic multi-spectrometry (REMS) is an innovative, non-ionizing diagnostic technique that has shown high accuracy and precision, making it a promising alternative to DXA for osteoporosis diagnosis in clinical settings. With economic considerations playing an increasingly crucial role in healthcare decisions, this study aims to evaluate the cost-effectiveness and economic impact of improved osteoporosis diagnosis using REMS followed by treatment in the United States. A microsimulation-based Markov model was constructed to estimate the cost per quality-adjusted life year (QALY) gained (in US$2022) for REMS followed by treatment vs no diagnosis and treatment in US women aged 50 yr and older with osteoporosis. Women were categorized as high risk (receiving alendronate monotherapy for 5 yr) or very high risk (receiving an 18-mo course of anabolic treatment, abaloparatide, followed by 5 yr of alendronate). The study evaluated 2 medication adherence scenarios: one assuming full adherence to treatment and the other reflecting real-world adherence. The results indicate that REMS followed by treatment is associated with improved health outcomes, including more QALYs and fewer fractures, and reduced fracture-related costs compared to no diagnosis and treatment. The incremental cost-effectiveness ratio of REMS was estimated at $33 891 and $49 198 per QALY gained, under the full adherence and real-world adherence scenarios, respectively. These values are below the US cost-effectiveness threshold of $100 000 per QALY. Moreover, a 5% increase in the diagnosis and treatment of women over 50 yr at high and very high risk of fractures using REMS is projected to save approximately 30 000 life yr, 43 500 QALYs, and prevent 100 000 fractures over a lifetime under real-world medication adherence. In conclusion, this study suggests that REMS is a cost-effective strategy for the diagnosis and management of osteoporosis in US women, offering substantial potential economic benefits and improved health outcomes.
射频超声多光谱测定法（REMS）是一种创新的非电离诊断技术，已显示出高准确性和精确性，使其成为临床环境中用于骨质疏松症诊断的双能X线吸收法（DXA）的一种有前景的替代方法。鉴于经济因素在医疗保健决策中发挥着越来越关键的作用，本研究旨在评估在美国使用REMS进行骨质疏松症诊断并随后进行治疗的成本效益和经济影响。构建了一个基于微观模拟的马尔可夫模型，以估计50岁及以上患有骨质疏松症的美国女性采用REMS诊断并随后治疗相对于不进行诊断和治疗每获得一个质量调整生命年（QALY）所花费的成本（以2022年美元计）。女性被分为高风险组（接受阿仑膦酸钠单药治疗5年）或极高风险组（接受18个月的促合成代谢治疗疗程，即阿巴洛肽，随后再接受5年阿仑膦酸钠治疗）。该研究评估了两种药物依从性情景：一种假设完全依从治疗，另一种反映实际的依从情况。结果表明，与不进行诊断和治疗相比，采用REMS诊断并随后治疗与改善的健康结果相关，包括更多的QALY和更少的骨折，以及降低的骨折相关成本。在完全依从和实际依从情景下，REMS每获得一个QALY的增量成本效益比分别估计为33,891美元和49,198美元。这些数值低于美国每QALY 100,000美元的成本效益阈值。此外，预计在实际药物依从情况下，使用REMS对50岁及以上骨折高风险和极高风险女性的诊断和治疗增加5%，在一生中可节省约30,000生命年、43,500个QALY，并预防100,000例骨折。总之，本研究表明，REMS是美国女性骨质疏松症诊断和管理的一种具有成本效益的策略，具有可观的潜在经济效益和改善的健康结果。
