Remote Management of Osteoporosis Screening and Treatment in US Veterans using a Bone Health Team: A Cost-effectiveness Analysis

Background/Purpose: To evaluate the cost effectiveness of a bone health team (BHT) as a primary prevention service to screen, monitor, and treat Veterans at risk for fragility fractures compared to current clinical practice from the Veteran’s Administration (VA) perspective over a life-time.

Methods: We conducted this analysis by adapting a previously validated Markov microsimulation model of osteoporosis incidence and outcomes in the VA. The model was used to estimate fracture events, quality-adjusted life years (QALYs), and direct healthcare costs of using a BHT vs current clinical practice. Model inputs were derived from national sources, published literature, and program estimates from the BHT. Uncertainty in model parameters was assessed by conducting one-way and probabilistic sensitivity analyses. 

Results: In the base-case, the BHT was associated with a substantially higher proportion of patients with underlying osteoporosis or osteopenia diagnosed and treated with bisphosphonates (osteoporosis: 38.0% vs 6.9%, osteopenia: 25.5% vs 0.2%). This resulted in the BHT strategy being associated with a modestly lower fracture rate than current clinical practice. In probabilistic sensitivity analysis, the BHT was the dominant option; however, in all analyses, no meaningful differences were observed in life-time estimated costs, unadjusted survival, and QALYs between the prevention strategies.

Conclusion: A BHT appears to be a potentially cost-effective method for screening and treating US Veterans for osteoporosis compared to no intervention.  Quality improvement programs addressing primary prevention of osteoporotic fractures provide a feasible, team-based, approach to this important problem, while unburdening the increasingly limited time and availability of primary care providers.