Journal of Clinical Densitometry
Volume 9, Issue 2 , Pages 133-143 , April 2006

Cost-Effectiveness of Vertebral Fracture Assessment to Detect Prevalent Vertebral Deformity and Select Postmenopausal Women With a Femoral Neck T-Score>−2.5 for Alendronate Therapy: A Modeling Study

  • John T. Schousboe

      Affiliations

    • Park Nicollet Health Services, Minneapolis, MN
    • Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, MN
    • Corresponding Author InformationAddress correspondence to: John T. Schousboe, MD, MS, Park Nicollet Clinic, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416.
    • ,
  • Kristine E. Ensrud

      Affiliations

    • Department of Medicine, Veterans Administration Medical Center, Minneapolis, MN
    • Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN
    • ,
  • John A. Nyman

      Affiliations

    • Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, MN
    • ,
  • Robert L. Kane

      Affiliations

    • Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, MN
    • Clinical Outcomes Research Center, University of Minnesota, Minneapolis, MN
    • ,
  • L. Joseph Melton III

      Affiliations

    • Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN

Received 4 September 2005 ,Revised 7 October 2005 ,Accepted 1 November 2005.

References 

  1. Melton LJ. Adverse outcomes of osteoporotic fractures in the general population. J Bone Miner Res. 2003;18:1139–1141
  2. Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet. 1993;341(8837):72–75
  3. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254–1259
  4. Cranney A, Wells G, Willan A, et al. Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev. 2002;23:508–516
  5. Cranney A, Tugwell P, Adachi J, et al. Meta-analyses of therapies for postmenopausal osteoporosis. III. Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis. Endocr Rev. 2002;23:517–523
  6. Johnell O, Jonsson B, Jonsson L, et al. Cost effectiveness of alendronate (Fosamax) for the treatment of osteoporosis and prevention of fractures. Pharmacoeconomics. 2003;21:305–314
  7. Iglesias CP, Torgerson DJ, Bearne A, et al. The cost utility of bisphosphonate treatment in established osteoporosis. QJM. 2002;95:305–311
  8. Kanis JA, Borgstrom F, Johnell O, et al. Cost-effectiveness of risedronate for the treatment of osteoporosis and prevention of fractures in postmenopausal women. Osteoporos Int. 2004;15:862–871
  9. Siris ES, Chen YT, Abbott TA, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004;164:1108–1112
  10. Wainwright SA, Marshall LM, Ensrud KE, et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. 2005;90:2787–2793
  11. Singh S, Sun H, Anis AH. Cost-effectiveness of hip protectors in the prevention of osteoporosis related hip fractures in elderly nursing home residents. J Rheumatol. 2004;31:1607–1613
  12. National Osteoporosis Foundation. Physician guide to prevention and treatment of osteoporosis. Available at: http://www.nof.org/physguide/index.htm. Accessed January 15, 2005.
  13. Schousboe JT, Nyman JA, Kane RL, et al. Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med. 2005;142:734–741
  14. Black DM, Arden NK, Palermo L, et al. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 1999;14:821–828
  15. Greenspan SL, von Stetten E, Emond SK, et al. Instant vertebral assessment: a noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis. J Clin Densitom. 2001;4:373–380
  16. Schousboe JT, DeBold CR, Bowles C, et al. Prevalence of vertebral compression fracture deformity by X-ray absorptiometry of lateral thoracic and lumbar spines in a population referred for bone densitometry. J Clin Densitom. 2002;5:239–246
  17. Vokes TJ, Dixon LB, Favus MJ. Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int. 2003;14:871–878
  18. U.S. Preventive Services Task Force . Screening for osteoporosis in postmenopausal women: recommendations and rationale. Ann Intern Med. 2002;137:526–528
  19. Weisbrod BA. The health care quadrilemma: an essay on technological change, insurance, quality of care, and cost containment. J Econ Lit. 1991;29:523–552
  20. Rettig RA. Medical innovation duels cost containment. Health Aff (Millwood). 1994;13(3):7–27
  21. Bodenheimer T. High and rising health care costs. Part 2: technologic innovation. Ann Intern Med. 2005;142:932–937
  22. Tunis SR. Economic analysis in healthcare decisions. Am J Manag Care. 2004;10:301–304
  23. Garber AM. 2004 Cost-effectiveness and evidence evaluation as criteria for coverage policy. Health Aff (Millwood) Suppl Web Exclusives: W4-284–296.
  24. Schousboe JT, Ensrud KE, Nyman JA, et al. Potential cost-effective use of spine radiographs to detect vertebral deformity and select osteopenic post-menopausal women for amino-bisphosphonate therapy. Osteoporos Int [online], August 31, 2005. URL:http://www.springerlink.com/openurl.asp?genre=article&id=doi:10.1007/s00198-005-1956-7.
  25. Melton LJ, Lane AW, Cooper C, et al. Prevalence and incidence of vertebral deformities. Osteoporos Int. 1993;3:113–119
  26. Melton LJ. History of the Rochester Epidemiology Project. Mayo Clin Proc. 1996;71:266–274
  27. Kanis JA, Johnell O, Oden A, et al. The risk and burden of vertebral fractures in Sweden. Osteoporos Int. 2004;15:20–26
  28. Nevitt MC, Ettinger B, Black DM, et al. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med. 1998;128:793–800
  29. De Laet CE, van Hout BA, Burger H, et al. Bone density and risk of hip fracture in men and women: cross sectional analysis. BMJ. 1997;315(7102):221–225
  30. De Laet CE, Van Hout BA, Burger H, et al. Hip fracture prediction in elderly men and women: validation in the Rotterdam study. J Bone Miner Res. 1998;13:1587–1593
  31. Jones G, White C, Nguyen T, et al. Prevalent vertebral deformities: relationship to bone mineral density and spinal osteophytosis in elderly men and women. Osteoporos Int. 1996;6:233–239
  32. Leidig-Bruckner G, Limberg B, Felsenberg D, et al. Sex difference in the validity of vertebral deformities as an index of prevalent vertebral osteoporotic fractures: a population survey of older men and women. Osteoporos Int. 2000;11:102–119
  33. Black DM, Palermo L, Nevitt MC, et al. Comparison of methods for defining prevalent vertebral deformities: the study of osteoporotic fractures. J Bone Miner Res. 1995;10:890–902
  34. Rea JA, Li J, Blake GM, Steiger P, et al. Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int. 2000;11:660–668
  35. Melton LJ, Crowson CS, O'Fallon WM. Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int. 1999;9:29–37
  36. Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA. 1998;280:2077–2082
  37. Quandt SA, Thompson DE, Schneider DL. Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of −1.6 to −2.5 at the femoral neck: the Fracture Intervention Trial. Mayo Clin Proc. 2005;80:343–349
  38. Kanis JA, Johnell O, Black DM, et al. Effect of raloxifene on the risk of new vertebral fracture in postmenopausal women with osteopenia or osteoporosis: a reanalysis of the Multiple Outcomes of Raloxifene Evaluation trial. Bone. 2003;33:293–300
  39. Kanis JA, Barton IP, Johnell O. Risedronate decreases fracture risk in patients selected solely on the basis of prior vertebral fracture. Osteoporos Int. 2005;16:475–482
  40. Tosteson AN, Jonsson B, Grima DT, et al. Challenges for model-based economic evaluations of postmenopausal osteoporosis interventions. Osteoporos Int. 2001;12:849–857
  41. United States 1999 Life Tables. 2002 Natl Vital Stat Rep 50(6):17–18.
  42. Kanis JA, Johansson H, Oden A, et al. How many deaths from hip fracture might be prevented? Proceedings of the 24th Meeting of the American Society for Bone and Mineral Research, San Antonio, Texas. J Bone Miner Res. 2002;17(Suppl 1):S146
  43. Melton LJ. Excess mortality following vertebral fracture. J Am Geriatr Soc. 2000;48:338–339
  44. Kanis JA, Borgstrom F, Johnell O. Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study. Osteoporos Int. 2005;16:15–25
  45. Drug Topics 2001 Red Book. New Jersey: Medical Economics Co.
  46. Gabriel SE, Tosteson AN, Leibson CL, et al. Direct medical costs attributable to osteoporotic fractures. Osteoporos Int. 2002;13:323–330
  47. Leibson CL, Tosteson AN, Gabriel SE, et al. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc. 2002;50:1644–1650
  48. Meerding WJ, Looman CW, Essink-Bot ML, et al. Distribution and determinants of health and work status in a comprehensive population of injury patients. J Trauma. 2004;56:150–161
  49. Center for Medicare and Medicaid Services. Available at: http://cms.hhs.gov/providers/pufdownload/rvudown.asp. Accessed August 12, 2003.
  50. Burström K, Johannesson M, Diderichsen F. Swedish population health-related quality of life results using the EQ-5D. Qual Life Res. 2001;10:621–635
  51. Kind P, Dolan P, Gudex C, Williams A. Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ. 1998;316(7133):736–741
  52. Macran S, Weatherly H, Kind P. Measuring population health: a comparison of three generic health status measures. Med Care. 2003;41:218–231
  53. Tosteson AN, Gabriel SE, Grove MR, et al. Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int. 2001;12:1042–1049
  54. Oleksik A, Lips P, Dawson A, et al. Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res. 2000;15:1384–1392
  55. O'Neill TW, Cockerill W, Matthis C, et al. Back pain, disability, and radiographic vertebral fracture in European women: a prospective study. Osteoporos Int. 2004;15:760–765
  56. Doubilet P, Begg CB, Weinstein MC, et al. Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach. Med Decis Making. 1985;5:157–177
  57. Halpern EF, Weinstein MC, Hunink MG, Gazelle GS. Representing both first- and second-order uncertainties by Monte Carlo simulation for groups of patients. Med Decis Making. 2000;20:314–322
  58. Melton LJ, Chrischilles EA, Cooper C, et al. Perspective: how many women have osteoporosis?. J Bone Miner Res. 1992;7:1005–1010
  59. Hirth R, Chernow M, Miller E, Fendrick A, Weissert W. Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making. 2000;20:332–342
  60. Ubel PA, Hirth RA, Chernew ME, Fendrick AM. What is the price of life and why doesn't it increase at the rate of inflation?. Arch Intern Med. 2003;163:1637–1641
  61. Delmas PD, Genant HK, Crans GG, et al. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone. 2003;33:522–532
  62. Fisher ES, Wennberg DE, Stukel TA, et al. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138:273–287
  63. Fisher ES, Wennberg DE, Stukel TA, et al. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138:288–298
  64. Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991;114:919–923
  65. Ismail AA, Cockerill W, Cooper C, et al. Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European Prospective Osteoporosis Study. Osteoporos Int. 2001;12:85–90
  66. Ross PD, Genant HK, Davis JW, et al. Predicting vertebral fracture incidence from prevalent fractures and bone density among non-black, osteoporotic women. Osteoporos Int. 1993;3:120–126

PII: S1094-6950(06)00011-4

doi: 10.1016/j.jocd.2005.11.004

Journal of Clinical Densitometry
Volume 9, Issue 2 , Pages 133-143 , April 2006

Article Tools

* Image Usage & Resolution