Background: The prevalent vertebral fracture (VF) is a risk factor for future VF, which can be decreased with drug therapy. However, most VFs are not recognized clinically. VFA by DXA and spine X-ray can be performed to detect these prevalent VFs.
Objectives: This study aimed to estimate the costs, effectiveness, and radiation exposure of VF diagnostic strategies.
Methods: Markov model over a 10-year period was used to calculate the medical costs for diagnostic tests and VF treatment, the reduction of incident VFs of patients who have experienced a VF, and the radiation doses in population aged over 50. We compared three strategies: VFA followed by confirmatory radiography (VFA screening), only VFA and only X-ray every 2 years, to no test before recognition. We assumed that all patients tested positive for VF received drug therapy. A discount rate of 5% was applied in cost.
Results: The results showed the incremental costs for women over age 50 who had VFA screening, only VFA, and only X-ray were &z.euro;838, &z.euro;1165, and &z.euro;957 per person respectively. Future VF incidence was reduced in all strategies by 29% in both VFA screening and only VFA and 35% in only X-ray as compared with no test for 10 years. Also, the level of radiation in X-ray was 2647 μSv and 3253 μSv higher than in VFA screening and only VFA. For men, both the effects and costs were decreased, but trends were similar to the results of women. The sensitivity analyses showed that these results are robust to variety assumptions including cycle length (1 year), costs, and diagnostic accuracy.
Conclusion: VFA screening strategy can be relevant option for future VF prevention as considering lower cost, less radiation, and patient convenience. This study is expected to provide useful information as establishing the VF diagnostic strategy in clinical practice.
Conclusion: The VFA using DXA appeared to have a moderate sensitivity and a high specificity for detecting vertebral fracture.
17 May 2014 - 20 May 2014