The cost-effectiveness of screening in the community to reduce osteoporotic fractures in older women in the UK: economic evaluation of the SCOOP study

The ‘SCOOP’ study was a two-arm randomised controlled trial conducted in the UK in 12 483 eligible women aged 70 to 85 years. It compared a screening programme using the FRAX® risk assessment tool in addition to BMD measures versus usual management. The SCOOP studyfound a reduction in the incidence of hip fractures in the screening arm, but there was no evidence of a reduction in the incidence of all osteoporosis related fractures. In order to make decisions about whether to implement any screening programme we should also consider whether the programme is likely to be a good use of health care resources, i.e., is it cost-effective? The cost per gained quality adjusted life year (QALY) of screening for fracture risk has not previously been demonstrated in an economic evaluation alongside a clinical trial. We conducted a ‘within trial’ economic analysis alongside the ‘SCOOP’ study from the perspective of a National Health payer, the UK National Health Service (NHS). The main outcome measure in the economic analysis was the cost per quality adjusted life year (QALY) gained over a 5-year time period. We also estimated cost per osteoporosis-related fracture prevented and the cost per hip fracture prevented. The screening arm had an average incremental QALY gain of 0.0237 (-0.0034, 0.0508) for the five year follow-up. The incremental cost per QALY gained was £2,772 compared to the control arm. Cost-effectiveness acceptability curves indicated a 93% probability of the intervention being cost-effective at values of a QALY greater than £20,000. The intervention arm prevented fractures at a cost of £4,478 and £7,694 per fracture for osteoporosis-related and hip fractures respectively. The current study demonstrates that a systematic, community-based screening programme of fracture risk in older women in the UK represents a highly cost-effective intervention.