Screening for osteoporosis in Chinese post-menopausal women: a health economic modelling study

L. Si, T. M. Winzenberg, M. Chen, Q. Jiang, A. Neil, A. J. Palmer

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Summary: Screening and appropriate treatment for osteoporosis has been proven to be cost-effective in many populations; however, it is not clear in the Chinese population. Simulations using a validated health economics model suggest that screening for osteoporosis in Chinese women is cost-effective and may even be cost-saving in Chinese post-menopausal women. Introduction: This study aimed at determining the cost-effectiveness of osteoporosis screening strategies in post-menopausal Chinese women. Methods: A validated state-transition microsimulation model with a lifetime horizon was used to evaluate the cost-effectiveness of different screening strategies with treatment of alendronate compared with current osteoporosis management in China. Osteoporosis screening strategies assessed were (1) universal screening with dual-energy X-ray absorptiometry (DXA) alone; (2) Osteoporosis Self-Assessment Tool for Asians (OSTA) + DXA; and (3) quantitative ultrasound (QUS) + DXA with rescreening at 2, 5 or 10-year intervals for patients screened negative by DXA. The study was performed from the Chinese healthcare payer’s perspective. All model inputs were retrieved from publically available literature. Uncertainties were addressed by one-way and probabilistic sensitivity analysis. Results: Screening strategies all improved clinical outcomes at increased costs, and each were cost-effective compared with no screening in women aged 55 years given the Chinese willingness-to-pay threshold of USD 20,000 per quality-adjusted life year (QALY) gained. Pre-screening with QUS and subsequent DXA screening if the QUS T-score ≤ −0.5 with a 2-year rescreening interval was the most cost-effective strategy with the highest probability of being cost-effective across all non-dominated strategies. Screening strategies were cost-saving if screenings were initiated from age 65 years. One-way sensitivity analyses indicated that the results were robust. Conclusions: Pre-screening with QUS with subsequent DXA screening if the QUS T-score ≤ −0.5 with a 2-year rescreening interval in the Chinese women starting at age 55 is the most cost-effective. In addition, screening and treatment strategies are cost-saving if the screening initiation age is greater than 65 years.

LanguageEnglish
Pages2259-2269
Number of pages11
JournalOsteoporosis International
Volume27
Issue number7
DOIs
Publication statusPublished - 1 Jul 2016
Externally publishedYes

Fingerprint

Women's Health
Osteoporosis
Photon Absorptiometry
Economics
Costs and Cost Analysis
Cost-Benefit Analysis
Economic Models
Alendronate
Quality-Adjusted Life Years
Health Care Costs
Population
Uncertainty
China
Delivery of Health Care
Health
Therapeutics

Keywords

  • Chinese
  • Health economics
  • Osteoporosis
  • Post-menopausal women
  • Screening

Cite this

Si, L. ; Winzenberg, T. M. ; Chen, M. ; Jiang, Q. ; Neil, A. ; Palmer, A. J. / Screening for osteoporosis in Chinese post-menopausal women : a health economic modelling study. In: Osteoporosis International. 2016 ; Vol. 27, No. 7. pp. 2259-2269.
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Screening for osteoporosis in Chinese post-menopausal women : a health economic modelling study. / Si, L.; Winzenberg, T. M.; Chen, M.; Jiang, Q.; Neil, A.; Palmer, A. J.

In: Osteoporosis International, Vol. 27, No. 7, 01.07.2016, p. 2259-2269.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Screening for osteoporosis in Chinese post-menopausal women

T2 - Osteoporosis International

AU - Si, L.

AU - Winzenberg, T. M.

AU - Chen, M.

AU - Jiang, Q.

AU - Neil, A.

AU - Palmer, A. J.

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N2 - Summary: Screening and appropriate treatment for osteoporosis has been proven to be cost-effective in many populations; however, it is not clear in the Chinese population. Simulations using a validated health economics model suggest that screening for osteoporosis in Chinese women is cost-effective and may even be cost-saving in Chinese post-menopausal women. Introduction: This study aimed at determining the cost-effectiveness of osteoporosis screening strategies in post-menopausal Chinese women. Methods: A validated state-transition microsimulation model with a lifetime horizon was used to evaluate the cost-effectiveness of different screening strategies with treatment of alendronate compared with current osteoporosis management in China. Osteoporosis screening strategies assessed were (1) universal screening with dual-energy X-ray absorptiometry (DXA) alone; (2) Osteoporosis Self-Assessment Tool for Asians (OSTA) + DXA; and (3) quantitative ultrasound (QUS) + DXA with rescreening at 2, 5 or 10-year intervals for patients screened negative by DXA. The study was performed from the Chinese healthcare payer’s perspective. All model inputs were retrieved from publically available literature. Uncertainties were addressed by one-way and probabilistic sensitivity analysis. Results: Screening strategies all improved clinical outcomes at increased costs, and each were cost-effective compared with no screening in women aged 55 years given the Chinese willingness-to-pay threshold of USD 20,000 per quality-adjusted life year (QALY) gained. Pre-screening with QUS and subsequent DXA screening if the QUS T-score ≤ −0.5 with a 2-year rescreening interval was the most cost-effective strategy with the highest probability of being cost-effective across all non-dominated strategies. Screening strategies were cost-saving if screenings were initiated from age 65 years. One-way sensitivity analyses indicated that the results were robust. Conclusions: Pre-screening with QUS with subsequent DXA screening if the QUS T-score ≤ −0.5 with a 2-year rescreening interval in the Chinese women starting at age 55 is the most cost-effective. In addition, screening and treatment strategies are cost-saving if the screening initiation age is greater than 65 years.

AB - Summary: Screening and appropriate treatment for osteoporosis has been proven to be cost-effective in many populations; however, it is not clear in the Chinese population. Simulations using a validated health economics model suggest that screening for osteoporosis in Chinese women is cost-effective and may even be cost-saving in Chinese post-menopausal women. Introduction: This study aimed at determining the cost-effectiveness of osteoporosis screening strategies in post-menopausal Chinese women. Methods: A validated state-transition microsimulation model with a lifetime horizon was used to evaluate the cost-effectiveness of different screening strategies with treatment of alendronate compared with current osteoporosis management in China. Osteoporosis screening strategies assessed were (1) universal screening with dual-energy X-ray absorptiometry (DXA) alone; (2) Osteoporosis Self-Assessment Tool for Asians (OSTA) + DXA; and (3) quantitative ultrasound (QUS) + DXA with rescreening at 2, 5 or 10-year intervals for patients screened negative by DXA. The study was performed from the Chinese healthcare payer’s perspective. All model inputs were retrieved from publically available literature. Uncertainties were addressed by one-way and probabilistic sensitivity analysis. Results: Screening strategies all improved clinical outcomes at increased costs, and each were cost-effective compared with no screening in women aged 55 years given the Chinese willingness-to-pay threshold of USD 20,000 per quality-adjusted life year (QALY) gained. Pre-screening with QUS and subsequent DXA screening if the QUS T-score ≤ −0.5 with a 2-year rescreening interval was the most cost-effective strategy with the highest probability of being cost-effective across all non-dominated strategies. Screening strategies were cost-saving if screenings were initiated from age 65 years. One-way sensitivity analyses indicated that the results were robust. Conclusions: Pre-screening with QUS with subsequent DXA screening if the QUS T-score ≤ −0.5 with a 2-year rescreening interval in the Chinese women starting at age 55 is the most cost-effective. In addition, screening and treatment strategies are cost-saving if the screening initiation age is greater than 65 years.

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