Comparative Effectiveness and Cost-Effectiveness of Osteoporosis Screening Strate

描述(由申请人提供)：美国有1000万人患有骨质疏松症，相关的发病率、死亡率和成本都很高。对骨质疏松性骨折风险增加的个体进行筛查和治疗可以大大降低骨折风险，改善健康结果。目前有多种骨质疏松症筛查试验，包括双能X射线骨密度仪(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，对于老年女性和男性最有效和最具成本效益的人群筛查策略，特别是哪些测试或测试序列、筛查开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模式和最佳筛查间隔的适当使用至关重要。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战略，这些战略可以实施，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，这些工具和QCT的性能特征目前没有得到很好的定义(目标1)。然后，我们将使用这些信息，以及关于其他骨质疏松症筛查测试(DXA和QUS)、骨质疏松症相关成本和骨质疏松症相关结果的已发表数据，构建全面的微观模拟成本效益模型，以比较50岁及以上女性和60岁及以上男性(目标2和3)的多重筛查测试、开始年龄和间隔时间。之前没有研究对我们计划比较的大范围筛查选项进行比较。我们的发现将包括为临床医生和政策制定者提供关于骨质疏松症筛查策略的具体建议，这些策略可以实施，以改善老年人的健康结果。 公共卫生相关性：骨质疏松症影响着1000万美国人，并与相当大的发病率、死亡率和成本有关。这项拟议研究的目标是确定针对美国老年女性和男性的最有效和最具成本效益的骨质疏松症人群筛查战略，这些战略可以实施，以改善健康结果。

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. PUBLIC HEALTH RELEVANCE: Osteoporosis affects 10 million Americans, and is associated with substantial morbidity, mortality, and costs. The goal of this proposed research is to identify the most effective and cost-effective osteoporosis population screening strategies for older U.S. women and men that can be implemented to improve health outcomes.