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  • December 2005

    Cost Benefits and Budgetary Impacts of Increased Osteoporosis Screening

    Journal of the American Geriatrics Society, Osteoporosis International | John T. Schousboe et al., Alison B. King et al.

    Articles:

    Article 1 – Universal Bone Densitometry Screening Combined with Alendronate Therapy for Those Diagnosed with Osteoporosis Is Highly Cost-Effective for Elderly Women

    Article 2 – Fracture Reduction Affects Medicare Economics (FRAME): Impact of increased osteoporosis diagnosis and treatment

    Authors:

    Article 1 – John T. Schousboe, MD, MS; Kristine E. Ensrud, M. MPH; John A. Nyman, PhD; L. Joseph Melton III, MD; MPH; Robert L. Kane, MD

    Article 2 – Alison B. King; K.G. Saag; R.T. Burge; M. Pisu; and N. Goel

    Journal:

    Article 1 – Journal of the American Geriatrics Society, 53:1697-1704, 2005

    Article 2 – Osteoporosis International, 16:1545-1557, 2005

    Summary:

    Affecting an estimated 5 million American women over the age of 65, Osteoporosis is among the most debilitating threats to Medicare beneficiaries in our country today. Unfortunately, rates of diagnosis and treatment for Osteoporosis have not increased in a manner congruent with advancements in diagnostic tests and availability of therapy. The following two studies were conducted to explore avenues for improvement through increased bone densitometry screening and treatment, specifically addressing the cost-effectiveness and budgetary impacts of such strategies.

    In the first study, Schousboe et al examined the costs and benefits of a “screen-and-treat” intervention strategy vs. no intervention, evaluating cost-effectiveness by measuring quality adjusted life years (QALY), costs and incremental cost-effectiveness ratios. If the cost of the screenand- treat process was less than that of no intervention, and the process resulted in an increase in QALYs, then the strategy was deemed cost

    saving. If the strategy did not technically prove to be cost saving, but the cost per QALY gained remained below the $50,000-$100,000 range, it was still considered to be cost-effective (Ubel et al). In the second study, King et al examined the budgetary impact of testing the bone mineral density (BMD) of an additional one (1) million women. The selected population of Caucasian women aged 65, 75, 85 or 95 were stratified into two groups: high-risk for osteoporosis, and moderate-risk. Researchers estimated the cost of fractures to Medicare, as well as the impact of increasing osteoporosis diagnosis and treatment.

    Study 1: Cost-effectiveness—Based on the researchers’ defined criteria for measurement, increased screening was considered as “highly costeffective” across the board, and in some cases was actually cost saving. The cost per QALY gained for 65-year-old women was $43,000; for 75-year-old women, $5,600. For 85- and 95-year-old women, the

    screen-and-treat was cost saving. Study 2: Budgetary Impacts—Researchers projected that BMD testing for an additional one (1) million women in 2001 would result in $77.86 million net savings for Medicare. According to their projections, the additional screenings would lead to the treatment of 440,000 new patients, preventing more than 35,000 fractures over the next three (3) years. However, despite the resulting quality of life improvements, out-of-pocket patient costs would accordingly increase by $63.49 million

    ($1,171 per fracture avoided). Ultimately, researchers concluded that increased testing for at-risk women may create savings for Medicare, while universal screening might have a neutral effect on budgets.

    Click here to access and read the full article. Click here for the second article. Please note that access to the full text of some articles may require a subscription or one-time fee.

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