Comparative Effectiveness and Cost-Effectiveness of Osteoporosis Screening Strate

骨质疏松症筛查策略的有效性和成本效益比较

• 批准号: 8508343
• 负责人: Smita Nayak
• 金额: $ 16.49万
• 依托单位: SWEDISH MEDICAL CENTER, FIRST HILL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8508343
• 关键词: Activities of Daily Living; Adult; Adverse event; Advisory Committees; Affect; Age; Age-Years; American; Bone Density; Categories; Characteristics; Clinical Trials; Consensus; Data; Diagnosis; Discipline of Nursing; Effectiveness; Elderly; Evaluation; Fracture; Future; Goals; Health; Hip Fractures; Hip region structure; Individual; Literature; Measurement; Meta-Analysis; Modality; Modeling; Morbidity - disease rate; Osteoporosis; Outcome; Pain; Participant; Patients; Performance; Pharmaceutical Preparations; Population; Postmenopause; Preventive; Publishing; Recommendation; Research; Review Literature; Risk; Risk Assessment; Risk Factors; Screening procedure; Sensitivity and Specificity; Services; Structure; Techniques; Testing; Three-Dimensional Image; Time; Treatment Efficacy; United States; Vertebral column; Woman; X-Ray Computed Tomography; aged; bone; comparative effectiveness; cost; cost effective; cost effectiveness; evidence base; follow-up; improved; instrument; medication compliance; men; models and simulation; mortality; older men; older women; osteoporosis with pathological fracture; performance tests; quantitative ultrasound; systematic review; tool; treatment strategy; trial comparing

DESCRIPTION (provided by applicant): Osteoporosis affects 10 million people in the U.S., and the associated morbidity, mortality, and costs are significant. Screening and treatment of individuals at increased risk of osteoporotic fracture can substantially reduce fracture risk and improve health outcomes. There are multiple osteoporosis screening tests available, including dual-energy x-ray absorptiometry (DXA), risk assessment instruments, calcaneal quantitative ultrasound (QUS), and quantitative computed tomography (QCT). However, there is lack of an evidence-based consensus regarding the most effective and cost-effective population screening strategies for older women and men, specifically which tests or sequence of tests, screening initiation ages, and repeat screening intervals are best. The United States Preventive Services Task Force has identified that further research is of paramount importance to define the appropriate use of various osteoporosis screening modalities and optimal screening intervals. The goal of this proposed research is to identify best osteoporosis population screening strategies for older U.S. women and men that can be implemented to improve osteoporosis-related health outcomes. To achieve this goal, we will first systematically review the performance characteristics of risk assessment tools and QCT, whose performance characteristics are not currently well defined (Aim 1). We will then use this information, along with published data on performance of other osteoporosis screening tests (DXA and QUS), osteoporosis-related costs, and osteoporosis-related outcomes to construct comprehensive microsimulation cost-effectiveness models to compare multiple screening tests, initiation ages, and intervals for both women aged 50 and older and men aged 60 and older (Aims 2 and 3). No prior study has compared the large range of screening options we plan to compare. Our findings will include specific recommendations for clinicians and policymakers regarding osteoporosis screening strategies that can be implemented to improve health outcomes in older adults.

描述（由申请人提供）：骨质疏松症在美国影响着1000万人，相关的发病率、死亡率和费用是显著的。对骨质疏松性骨折风险增加的个体进行筛查和治疗可以显著降低骨折风险并改善健康结果。有多种骨质疏松症筛查试验，包括双能x线吸收仪（DXA）、风险评估仪器、跟骨定量超声（QUS）和定量计算机断层扫描（QCT）。然而，对于老年妇女和男子最有效和最具成本效益的人群筛查策略，特别是哪些检测或检测顺序、筛查起始年龄和重复筛查间隔是最佳的，缺乏基于证据的共识。美国预防服务工作组已经确定，进一步的研究对于确定各种骨质疏松症筛查方式的适当使用和最佳筛查间隔是至关重要的。本研究的目的是为美国老年女性和男性确定最佳骨质疏松人群筛查策略，以改善骨质疏松相关的健康结果。为了实现这一目标，我们将首先系统地回顾风险评估工具和QCT的性能特征，它们的性能特征目前还没有很好地定义（目标1）。然后，我们将使用这些信息，以及其他骨质疏松筛查试验（DXA和QUS）、骨质疏松相关成本和骨质疏松相关结局的公开数据，构建全面的微观模拟成本-效果模型，以比较50岁及以上女性和60岁及以上男性的多种筛查试验、起始年龄和间隔时间（目标2和3）。之前没有研究比较过我们计划比较的大范围筛选方案。我们的研究结果将包括对临床医生和政策制定者关于骨质疏松症筛查策略的具体建议，这些策略可以改善老年人的健康结果。