Comparative Effectiveness and Cost-Effectiveness of Osteoporosis Screening Strate

描述（由申请人提供）： 骨质疏松症影响着美国1000万人，并且相关的发病率、死亡率和成本是显著的。筛查和治疗个体的风险增加的骨质疏松性骨折可以大大降低骨折的风险和改善健康的结果。有多种骨质疏松症筛查测试可用，包括双能X射线吸收法（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缺乏循证共识，特别是哪些测试或测试序列，筛查起始年龄和重复筛查间隔最好。美国预防服务工作组已经确定，进一步的研究是至关重要的，以确定适当使用各种骨质疏松症筛查模式和最佳筛查间隔。这项拟议研究的目标是为美国老年女性和男性确定最佳的骨质疏松症人群筛查策略，这些策略可以改善与骨质疏松症相关的健康结果。为了实现这一目标，我们将首先系统地审查风险评估工具和QCT的性能特征，其性能特征目前还没有得到很好的定义（目标1）。然后，我们将使用这些信息，沿着与其他骨质疏松筛查试验（DXA和QUS）的性能、骨质疏松相关成本和骨质疏松相关结局相关的已发表数据，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）。没有先前的研究比较了我们计划比较的大范围筛选选项。我们的研究结果将包括为临床医生和政策制定者提供的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状况。

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.