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Screening for fracture risk in older women is ‘highly cost-effective intervention’

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Systematic screening for fracture risk in older postmenopausal women would be a “highly cost-effective” use of NHS resources, according to researchers.

They concluded that community-based screening, using the Fracture Risk Assessment Tool (FRAX) plus bone density measurements, would result in savings by preventing osteoporosis-related fractures and hip fractures.

“A systematic, community-based screening programme represents a highly cost-effective intervention”

Study authors

The researchers examined results from a large randomised controlled trial, called SCOOP, which involved 12,483 women aged 70 to 85 years. It compared a screening programme using the FRAX risk assessment calculator in addition to bone mineral density measures versus usual management.

The average costs for the intervention were £104 per patient, with most of the money going towards case finding, dual-energy X-ray absorptiometry (DXA) scans, and GP consultations for those identified.

Taking into account this cost, the total average price tag for fracture-related healthcare over five years was estimated to be £968 and £900 for the intervention and control groups, respectively.

The main outcome measure used by the researchers in their economic analysis was the cost per quality adjusted life year (QALY) gained over the five-year time period. They also estimated cost per osteoporosis-related fracture prevented and the cost per hip fracture prevented.

They calculated that the additional cost per QALY was £2,772 compared with the control group in our base case analysis, which indicated a 93% probability of the intervention being cost-effective.

“The intervention also generated reductions in fractures with a cost per fracture prevented of £4478 for all osteoporotic fractures and £7694 for hip fractures,” said the study authors.

“Together, these results provide strong evidence that screening in the community to reduce fractures in older women represents an efficient use of health care resources,” they stated.

The researchers highlighted that, in the UK, around 536,000 people suffered fragility fractures each year, including 79,000 hip fractures.

Hip fractures alone had an estimated total cost of £3.5bn in 2010, which was expected to rise to £5.5bn by 2025, noted the study authors in the Journal of Bone and Mineral Research.

“For the individual, a hip fracture can be devastating with loss of independence, and less than one-third of patients make a full recovery; mortality at one year post-fracture is approximately 20%,” they said.

“This very large clinical trial, in over 12,000 participants, provided a unique opportunity”

David Turner

They added that they were not aware of any previous published study that had estimated cost per QALY using an economic evaluation conducted alongside a trial of screening to prevent fractures.

Lead author David Turner, from the University of East Anglia, said: “This cost-effectiveness study was conducted within a trial of screening to prevent osteoporotic fractures in elderly women.

“This very large clinical trial, in over 12,000 participants, provided a unique opportunity to investigate the cost-effectiveness of screening using information collected from a single large cohort,” he said.

“This showed screening to be cost-effective and to represent an important resource for healthcare decision-making, both in the UK and internationally,” he added.

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