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

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posted on 25.01.2018, 14:25 by David A. Turner, Rebekah Fong Soe Khioe, Lee Shepstone, Elizabeth Lenaghan, Cyrus Cooper, Neil Gittoes, Nicholas C. Harvey, Richard Holland, Amanda Howe, Eugene McCloskey, Terence W. O'Neill, David Torgerson, Richard Fordham, The SCOOP Study Team.
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.

Funding

The Arthritis Research United Kingdom (ARUK), formerly the Arthritis Research Campaign (ARC), and the Medical Research Council (MRC) of the UK, jointly funded this trial. The SCOOP study was designed and conducted with substantial input from the Norwich Clinical Trials Unit, UK, particularly the construction of the study database and provision of on-line randomisation (completed by Mr Tony Dyer). Invaluable advice and support were provided by Mrs Margaret McWilliams and Mrs Ann Pulford, the study’s public and patient involvement (PPI) representatives. We would like to acknowledge and thank our Trial Steering Committee and Data Monitoring Committee.

History

Citation

Journal of Bone and Mineral Research, 2018, 33

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Medical Education (Pre Nov 2017)

Version

VoR (Version of Record)

Published in

Journal of Bone and Mineral Research

Publisher

American Society for Bone and Mineral Research, Wiley

issn

0884-0431

eissn

1523-4681

Acceptance date

11/12/2017

Copyright date

2018

Available date

06/04/2018

Publisher version

https://onlinelibrary.wiley.com/doi/abs/10.1002/jbmr.3381

Language

en

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