Long-term cost-effectiveness of screening for fracture risk in a UK primary care setting:​ the SCOOP study

Söreskog, E.; Borgström, F.; Shepstone, L.; Clarke, S.; Cooper, C.; Harvey, I.; Harvey, N. C.; Howe, A.; Johansson, H.; Marshall, T.; O’Neill, T. W.; Peters, T. J.; Redmond, N. M.; Turner, D.; Holland, R.; McCloskey, E.; Kanis, J. A.

Affiliations

¹Quantify Research, Stockholm, Sweden

²LIME/MMC, Karolinska Institutet, Stockholm, Sweden

³Norwich Medical School, University of East Anglia, Norwich, UK

⁴Department of Rheumatology, University Hospitals Bristol, Bristol, UK

⁵MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

⁶NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

⁷Oxford Biomedical Research Unit, University of Oxford, Oxford, UK

⁸Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, UK

⁹Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

¹⁰Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia

¹¹Norfolk and Norwich University Hospital, Norwich, UK

¹²NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

¹³Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK

¹⁴Bristol Medical School, University of Bristol, Bristol, UK

¹⁵National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation, Bristol, UK

¹⁶Leicester Medical School, Centre for Medicine, University of Leicester, Leicester, UK

¹⁷Centre for Integrated research into Musculoskeletal Ageing, University of Sheffield Medical School, Sheffield, UK

¹⁸Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK

Abstract and keywords

Summary: Community-based screening and treatment of women aged 70–85 years at high fracture risk reduced fractures; moreover, the screening programme was cost-saving. The results support a case for a screening programme of fracture risk in older women in the UK.

Introduction: The SCOOP (screening for prevention of fractures in older women) randomized controlled trial investigated whether community-based screening could reduce fractures in women aged 70–85 years. The objective of this study was to estimate the long-term cost-effectiveness of screening for fracture risk in a UK primary care setting compared with usual management, based on the SCOOP study.

Methods: A health economic Markov model was used to predict the life-time consequences in terms of costs and quality of life of the screening programme compared with the control arm. The model was populated with costs related to drugs, administration and screening intervention derived from the SCOOP study. Fracture risk reduction in the screening arm compared with the usual management arm was derived from SCOOP. Modelled fracture risk corresponded to the risk observed in SCOOP.

Results: Screening of 1000 patients saved 9 hip fractures and 20 non-hip fractures over the remaining lifetime (mean 14 years) compared with usual management. In total, the screening arm saved costs (£286) and gained 0.015 QALYs/patient in comparison with usual management arm.

Conclusions: This analysis suggests that a screening programme of fracture risk in older women in the UK would gain quality of life and life years, and reduce fracture costs to more than offset the cost of running the programme.

Keywords: Cost-effectiveness; Fracture risk assessment; FRAX; UK; Randomized controlled trial

Links

DOI: 10.1007/s00198-020-05372-6

PubMed: 32239237

WoS: 000522894000001

History

Received: 2019-12-02

Accepted: 2020-02-28

Online: 2020-04-01

Cited Works (9)

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