Clinical Outcomes and Cost-Effectiveness of Osteoporosis Screening With Dual-Energy X-ray Absorptiometry

Chiao-Lin Hsu; Pin-Chieh Wu; Chun-Hao Yin; Chung-Hwan Chen; King-Teh Lee; Chih-Lung Lin; Hon-Yi Shi

doi:10.3348/kjr.2023.0555

Clinical Outcomes and Cost-Effectiveness of Osteoporosis Screening With Dual-Energy X-ray Absorptiometry

Korean J Radiol. 2023 Dec;24(12):1249-1259. doi: 10.3348/kjr.2023.0555.

Authors

Chiao-Lin Hsu^{1

2

3}, Pin-Chieh Wu¹, Chun-Hao Yin^{4

5}, Chung-Hwan Chen^{6

7}, King-Teh Lee^{3

8

9}, Chih-Lung Lin^{10

11}, Hon-Yi Shi^{3

12

13

14}

Affiliations

¹ Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
² Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
³ Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁵ Institute of Health Care Management, College of Management, National Sun Yat-sen University, Kaohsiung, Taiwan.
⁶ Department of Orthopaedics and Orthopaedic Research Center, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ Department of Orthopaedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
⁸ Department of Surgery, Park One International Hospital, Kaohsiung, Taiwan.
⁹ Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
¹⁰ Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
¹¹ Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹² Department of Business Management, College of Management, National Sun Yat-sen University, Kaohsiung, Taiwan.
¹³ Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
¹⁴ Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan. hshi@kmu.edu.tw.

Abstract

Objective: This study aimed to evaluate the clinical outcomes and cost-effectiveness of dual-energy X-ray absorptiometry (DXA) for osteoporosis screening.

Materials and methods: Eligible patients who had and had not undergone DXA screening were identified from among those aged 50 years or older at Kaohsiung Veterans General Hospital, Taiwan. Age, sex, screening year (index year), and Charlson comorbidity index of the DXA and non-DXA groups were matched using inverse probability of treatment weighting (IPTW) for propensity score analysis. For cost-effectiveness analysis, a societal perspective, 1-year cycle length, 20-year time horizon, and discount rate of 2% per year for both effectiveness and costs were adopted in the incremental cost-effectiveness (ICER) model.

Results: The outcome analysis included 10337 patients (female:male, 63.8%:36.2%) who were screened for osteoporosis in southern Taiwan between January 1, 2012, and December 31, 2021. The DXA group had significantly better outcomes than the non-DXA group in terms of fragility fractures (7.6% vs. 12.5%, P < 0.001) and mortality (0.6% vs. 4.3%, P < 0.001). The DXA screening strategy gained an ICER of US$ -2794 per quality-adjusted life year (QALY) relative to the non-DXA at the willingness-to-pay threshold of US$ 33004 (Taiwan's per capita gross domestic product). The ICER after stratifying by ages of 50-59, 60-69, 70-79, and ≥ 80 years were US$ -17815, US$ -26862, US$ -28981, and US$ -34816 per QALY, respectively.

Conclusion: Using DXA to screen adults aged 50 years or older for osteoporosis resulted in a reduced incidence of fragility fractures, lower mortality rate, and reduced total costs. Screening for osteoporosis is a cost-saving strategy and its effectiveness increases with age. However, caution is needed when generalizing these cost-effectiveness results to all older populations because the study population consisted mainly of women.

Keywords: Cost-saving; Dual-energy X-ray absorptiometry (DXA); Osteoporosis; Screening.

MeSH terms

Absorptiometry, Photon
Cost-Benefit Analysis
Cost-Effectiveness Analysis
Female
Humans
Male
Mass Screening / methods
Osteoporosis* / diagnostic imaging

Abstract

MeSH terms

Grants and funding