Cost-effectiveness analysis of DEXA versus existing technologies in Italy

Presenter: Marco Ratti, National Agency for Regional Health Care (Age.na.s.)

Abstract

Rationale: Osteoporosis is a disease which causes a reduction of the density and quality of bone this resulting in a higher risk of fracture. The most common fractures associated with osteoporosis occur at the wrist, hip and spine. The incidence of the last two fractures increases with age in both women and men, and they can result in serious consequences, such as loss of independent living, social isolation, deterioration of quality of life, surgery, death (etc.) As regard to hip fractures is high: within one year following a fracture, mortality in the hip fracture group is 10 per cent to 15 per cent higher than in a corresponding group of the same gender and age without hip fracture. Osteoporosis is common in the natural, biological aging process, but does not affect everyone equally. In women the rate of bone loss speeds up after menopause since the level of estrogens produced by the ovaries greatly decreases, indeed faster bone loss may also occur if both ovaries are removed by surgery. Due to the higher risk for post menopausal women to develop osteoporosis and its consequences, this is the target population chosen in this analysis. The WHO defines osteoporosis when is present a T score grater or equal to 2.5 which is the standard deviation below the young adult female mean. The bone mineral density (BMD) can be measured through various techniques, predicting fracture risk. Dual Energy X-ray Absorptiometry (DEXA), Quantitative Computer Tomography (QCT) and Quantitative Ultrasonography (QUS) are commonly used to diagnose osteoporosis.
Objectives: Our objective is to identify the first two most used techniques for the diagnosis of osteoporosis in the Italian context, and perform a cost effectiveness evaluation on the two selected diagnostic procedures, as part of a Health Technology Assessment report, commissioned by the Italian Ministry of Health National Commission of Biomedical Devices.
Methodology: We performed a systematic review to identify the available evidence on diagnostic accuracy, safety and economic impact on DEXA and its alternative, as a base of our assessment. Searches were run on the following databases: Medline, Embase and Cochrane Library and York database for HTA reports. Where possible a quantitative synthesis of the evidence will be performed. In case of not comparable homogenous methods and outcomes a qualitative synthesis will be provided via the use of specific tables. The following path allowed the collection of primary data on Italian context: access to the Italian hospital records (SDO) to highlight the volumes of inpatients care for osteoporosis in the last years; access to the available ambulatory care data for chosen diagnostic technologies; selection of representative centres to collect contextual data on costs of the procedures and technologies.
Results: We will update secondary research results (HTA reports, systematic reviews) diagnostic accuracy of the first two most widespread procedures used to diagnose osteoporosis. We will also systematically review the evidence about its economic impact and synthesise the results with appropriate tables.
Conclusions: DEXA, in Italy, is likely to be a cost-effective alternative compared with currently available options.