Community-Based Screening Cost-Effective for Osteoporotic Fracture Risk

physician examining woman's hands with rheumatoid arthritis
physician examining woman’s hands with rheumatoid arthritis
The SCOOP study evaluated screenings aimed at identifying older women who are at increased risk for fragility fractures.

Use of a systematic, community-based screening program to evaluate osteoporotic fracture risk among older women is a highly cost-effective intervention that represents an efficient use of healthcare resources, according to the results of the SCOOP (Screening for Prevention of Fractures in Older Women) study published in the Journal of Bone and Mineral Research.

The SCOOP study, which was conducted across 7 geographic regions in the United Kingdom, was designed to evaluate screenings aimed at identifying older women who are at increased risk for fragility fractures. A total of 12,483 eligible women from age 70 to 85 were assessed. Those already taking anti-osteoporosis medications, other than vitamin D and calcium, were excluded from the study.

Researchers used the FRAX risk assessment tool to calculate a 10-year hip fracture probability from participants who were randomly assigned to the screening group. Participants with a sufficiently high risk for fracture underwent dual-energy X-ray absorptiometry (DXA)-based bone mineral density (BMD) measurement, which was used to recalculate the participant’s 10-year hip fracture probability. Use of the screening program with FRAX plus DXA-based BMD measurements was compared with usual management.

The results showed that the screening program had the potential to reduce the incidence of hip fractures over the course of 5 years (hazard ratio [HR], 0.72; P =.002), but not fractures at other sites (HR, 0.94; P =.178).

The investigators also conducted a “within trial” economic analysis alongside the SCOOP study, from the perspective of the UK National Health Service, a national health payer. The main outcome measure in the economic analysis was the cost per quality-adjusted life-year (QALY) that was gained during a 5-year period. The researchers also estimated the cost per osteoporosis-related fracture prevented, as well as the cost per hip fracture prevented.

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In the screening group, there was an average incremental QALY gain of 0.0237 (95% CI, −0.0034 to 0.0508) for the 5-year follow-up. The incremental cost per QALY gained was £2772 compared with the control group. Cost-effectiveness acceptability curves demonstrated a 93% probability of the intervention being cost-effective at QALY values >£20,000. The intervention group prevented fractures at an incremental cost of £4478 per osteoporotic-related fracture and £7694 per hip fracture.

The investigators concluded that the present study provides strong evidence that community screening using FRAX probability of hip fracture in older women is a cost-effective, efficient method of reducing fractures among older woman.

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Turner DA, Khioe RFS, Shepstone L, et al; SCOOP Study Team. The cost-effectiveness of screening in the community to reduce osteoporotic fractures in older women in the UK: economic evaluation of the SCOOP Study [published online February 22, 2018]. J Bone Miner Res. doi: 10.1002/jbmr.3381