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

基本信息

批准号：
8449118
负责人：
Smita Nayak
金额：
$ 24.01万
依托单位：
SWEDISH MEDICAL CENTER, FIRST HILL
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-04-01 至 2015-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8449118
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 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 screening systematic review tool treatment strategy trial comparing

项目摘要

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）：骨质疏松症影响着美国 1000 万人，相关的发病率、死亡率和费用非常高。对骨质疏松性骨折风险较高的个体进行筛查和治疗可以大大降低骨折风险并改善健康结果。有多种骨质疏松症筛查测试可供选择，包括双能 X 射线吸收测定法 (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顺序、筛查起始年龄和重复筛查间隔最好，缺乏基于证据的共识。美国预防服务工作组已确定，进一步的研究对于确定各种骨质疏松症筛查方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策略，以改善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，其性能特征目前尚未明确定义（目标1）。然后，我们将使用这些信息以及已发布的其他骨质疏松症筛查测试（DXA 和 QUS）性能、骨质疏松症相关成本和骨质疏松症相关结果的数据来构建全面的微观模拟成本效益模型，以比较多种筛查测试、起始年龄，以及 50 岁及以上女性和 60 岁及以上男性的间隔（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查选项。我们的研究结果将包括为临床医生和政策制定者提供有关骨质疏松症筛查策略的具体建议，这些策略可用于改善老年人的健康结果。