Cost effectiveness analysis of using quantitative ultrasound as a selective pre-screen for bone densitometry

Area of Science:

• Medical Imaging
• Radiology
• Gerontology

Background:

• Dual energy X-ray absorptiometry (DXA) is a standard for bone mineral density (BMD) assessment.
• Quantitative ultrasound (QUS) has been proposed as a cost-effective pre-screening tool for DXA.
• Evaluating the cost-effectiveness of QUS as a pre-screening method for DXA is crucial for optimizing healthcare resources.

Purpose of the Study:

• To assess the cost-effectiveness of using QUS as a pre-screening tool for DXA in women referred for BMD assessment.
• To determine if QUS can selectively identify women who require DXA, thereby maximizing cost-effectiveness.

Main Methods:

• 115 women aged 40-80 years underwent both DXA (lumbar spine, hip) and QUS (heel broadband ultrasound attenuation - BUA).
• Cost analysis was performed using a bottom-up approach for both DXA and QUS.
• A BUA threshold was determined to identify women for referral to DXA, examining sensitivity and specificity.

Main Results:

• The cost of DXA was approximately 44 UK pounds, and QUS was 16 UK pounds.
• A BUA threshold of 60 dB/MHz yielded 81% sensitivity and 89% specificity for identifying osteoporosis by DXA.
• Pre-screening with QUS saved 969 UK pounds but missed ten women with osteoporosis, with a cost per additional case identified by DXA alone of 97 UK pounds.

Conclusions:

• QUS pre-screening does not offer a significant cost-effective benefit for DXA in the studied population.
• QUS pre-screening would only become cost-effective if its investigation costs were substantially reduced.
• DXA remains a more definitive diagnostic tool, and QUS's role as a cost-saving pre-screen requires further investigation into cost reduction.