Cost-minimization analysis to support the HTA of Radiofrequency Echographic Multi Spectrometry (REMS) in the diagnosis of osteoporosis
Keywords:Cost-minimization analysis, Dual-Energy X-ray Absorptiometry (DXA), Economic evaluation, Health Technology Assessment (HTA), osteoporosis, Radiofrequency Echographic Multi Spectrometry (REMS)
Introduction: A timely diagnosis of osteoporosis is key to reducing its growing clinical and economic burden. Radiofrequency Echographic Multi Spectrometry (REMS), a new diagnostic technology using an ultrasound approach, has been recognized by scientific associations as a facilitator of patients’ care pathway. We aimed at evaluating the costs of REMS vs. the conventional ionizing technology (dual-energy X-ray absorptiometry, DXA) for the diagnosis of osteoporosis from the perspective of the Italian National Health Service (NHS) using a cost-minimization analysis (CMA).
Methods: We carried out structured qualitative interviews and a structured expert elicitation exercise to estimate healthcare resource consumption with a purposeful sample of clinical experts. For the elicitation exercise, an Excel tool was developed and, for each parameter, experts were asked to provide the lowest, highest and most likely value. Estimates provided by experts were averaged with equal weights. Unit costs were retrieved using different public sources.
Results: Considering the base-case scenario (most likely value), the cost of professionals amounts to €31.9 for REMS and €48.8 for DXA, the cost of instrumental examinations and laboratory tests to €45.1 for REMS and €68.2 for DXA. Overall, in terms of current costs, REMS is associated with a mean saving for the NHS of €40.0 (range: €27.6-71.5) for each patient.
Conclusions: REMS is associated with lower direct healthcare costs with respect to DXA. These results may inform policy-makers on the value of the REMS technology in the earlier diagnosis for osteoporosis, and support their decision regarding the reimbursement and diffusion of the technology in the Italian NHS.
Consensus development conference. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94(6):646-650. https://doi.org/10.1016/0002-9343(93)90218-E PMID:8506892
Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359(9319):1761-1767. https://doi.org/10.1016/S0140-6736(02)08657-9 PMID:12049882
Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol. 2006;194(2)(suppl):S3-S11. https://doi.org/10.1016/j.ajog.2005.08.047 PMID:16448873
Salari N, Ghasemi H, Mohammadi L, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res. 2021;16(1):609. https://doi.org/10.1186/s13018-021-02772-0 PMID:34657598
International Osteoporosis Foundation, Fondazione FIRMO. OSSA SPEZZATE, VITE SPEZZATE: un piano d’azione per superare l’emergenza delle fratture da fragilità in Italia. 2017. https://www.osteoporosis.foundation/sites/iofbonehealth/files/2019-06/4.%202018_EU6Italy_Report_BrokenBonesBrokenLives_Italian.pdf. Accessed September 2022.
Pazianas M, Miller P, Blumentals WA, Bernal M, Kothawala P. A review of the literature on osteonecrosis of the jaw in patients with osteoporosis treated with oral bisphosphonates: prevalence, risk factors, and clinical characteristics. Clin Ther. 2007 Aug;29(8):1548-1558. https://doi.org/10.1016/j.clinthera.2007.08.008 PMID 17919538
Borgström F, Karlsson L, Ortsäter G, et al; International Osteoporosis Foundation. Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos. 2020;15(1):59. https://doi.org/10.1007/s11657-020-0706-y PMID:32306163
Clynes MA, Harvey NC, Curtis EM, Fuggle NR, Dennison EM, Cooper C. The epidemiology of osteoporosis. Br Med Bull. 2020;133(1):105-117. PMID:32282039
Khosla S, Hofbauer LC. Osteoporosis treatment: recent developments and ongoing challenges. Lancet Diabetes Endocrinol. 2017 Nov;5(11):898-907.
https://doi.org/10.1016/S2213-8587(17)30188-2 PMID: 28689769
Morris CA, Cabral D, Cheng H, et al. Patterns of bone mineral density testing: current guidelines, testing rates, and interventions. J Gen Intern Med. 2004;19(7):783-790. https://doi.org/10.1111/j.1525-1497.2004.30240.x PMID:15209594
Khosla S, Shane E. A crisis in the treatment of osteoporosis. J Bone Miner Res. 2016;31(8):1485-1487. https://doi.org/10.1002/jbmr.2888 PMID:27335158
Hernlund E, Svedbom A, Ivergård M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8(1):136. https://doi.org/10.1007/s11657-013-0136-1 PMID:24113837
International Osteoporosis Foundation. How fragile is her future? 2000. https://www.osteoporosis.foundation/sites/iofbonehealth/files/2020-04/how_fragile_is_her_future.pdf. Accessed September 2022.
Levine JP. Identification, diagnosis, and prevention of osteoporosis. Am J Manag Care. 2011;17(6)(suppl 6):S170-S176. PMID:21761956
Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002 Jun 1;359(9321):1929-1936.
https://doi.org/10.1016/S0140-6736(02)08761-5 PMID 12057569
Rossini M, Adami S, Bertoldo F, et al. Guidelines for the diagnosis, prevention and management of osteoporosis. Reumatismo. 2016 Jun 23;68(1):1-39.
Caffarelli C, Pitinca MDT, Francolini V, Alessandri M, Gonnelli S. REMS technique: future perspectives in an academic hospital. Clin Cases Miner Bone Metab. 2018;15(2):163-165. https://scholar.google.com/scholar_lookup?journal=Clin+Cases+Miner+Bone+Metab&title=REMS+technique:+future+perspectives+in+an+Academic+Hospital&author=C+Caffarelli&author=MD+Tomai+Pitinica&author=V+Francolini&volume=15&publication_year=2018&pages=163-165&
Di Paola M, Gatti D, Viapiana O, et al. Radiofrequency echographic multispectrometry compared with dual X-ray absorptiometry for osteoporosis diagnosis on lumbar spine and femoral neck. Osteoporos Int. 2019;30(2):391-402. https://doi.org/10.1007/s00198-018-4686-3 PMID:30178159
Diez-Perez A, Brandi ML, Al-Daghri N, et al. Radiofrequency echographic multi-spectrometry for the in-vivo assessment of bone strength: state of the art-outcomes of an expert consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Aging Clin Exp Res. 2019;31(10):1375-1389. https://doi.org/10.1007/s40520-019-01294-4 PMID:31422565
Casciaro S, Peccarisi M, Pisani P, et al. An advanced quantitative echosound methodology for femoral neck densitometry. Ultrasound Med Biol. 2016;42(6):1337-1356. https://doi.org/10.1016/j.ultrasmedbio.2016.01.024 PMID:27033331
Conversano F, Franchini R, Greco A, et al. A novel ultrasound methodology for estimating spine mineral density. Ultrasound Med Biol. 2015;41(1):281-300. https://doi.org/10.1016/j.ultrasmedbio.2014.08.017 PMID:25438845
Adami G, Arioli G, Bianchi G, et al. Radiofrequency echographic multi spectrometry for the prediction of incident fragility fractures: A 5-year follow-up study. Bone. 2020;134:115297. https://doi.org/10.1016/j.bone.2020.115297 PMID:32092480
Cortet B, Dennison E, Diez-Perez A, et al. Radiofrequency Echographic Multi Spectrometry (REMS) for the diagnosis of osteoporosis in a European multicenter clinical context. Bone. 2021;143:115786. https://doi.org/10.1016/j.bone.2020.115786 PMID:33278653
Sistema nazionale per le linee guida. Diagnosi, stratificazione del rischio e continuità assistenziale delle Fratture da Fragilità. 2021. https://snlg.iss.it/wp-content/uploads/2022/01/LG-392_Fratture-da-Fragilità_v2.pdf. Accessed September 2022.
Colson AR, Cooke RM. Expert elicitation: using the classical model to validate experts’ judgments. Rev Environ Econ Policy. 2018;12(1):113-132. https://doi.org/10.1093/reep/rex022
Bojke L, Soares M, Claxton K, et al. Developing a reference protocol for structured expert elicitation in health-care decision-making: a mixed-methods study. Health Technol Assess. 2021;25(37):1-124. https://doi.org/10.3310/hta25370 PMID:34105510
Soares MO, Bojke L. Expert elicitation to inform health technology assessment. In: Dias LC, Morton A, Quigley J, eds. Elicitation: the science and art of structuring judgement. Springer International Publishing 2018; 479-494. https://doi.org/10.1007/978-3-319-65052-4_18
Bojke L, Soares MO, Claxton K, et al. Reference case methods for expert elicitation in health care decision making. Med Decis Making. 2022;42(2):182-193. https://doi.org/10.1177/0272989X211028236 PMID:34271832
Creswell JW, Poth CN. Qualitative inquiry and research design: choosing among five approaches. SAGE Publications 2016. https://us.sagepub.com/en-us/nam/qualitative-inquiry-and-research-design/book246896
Ministero della Salute. Nomenclatore dell’assistenza specialistica ambulatoriale. http://www.salute.gov.it/portale/temi/p2_6.jsp?lingua=italiano&id=1767&area=programmazioneSanitariaLea&menu=lea. Accessed September 2022.
Conto annuale – Costo del lavoro. https://contoannuale.rgs.mef.gov.it/spese-e-retribuzioni/costo-del-lavoro. Accessed September 2022.
Determinazione del numero globale dei medici specialisti da formare per il triennio 2020/2023 ed assegnazione dei contratti di formazione medica specialistica alle tipologie di specializzazioni per l'anno accademico 2020/2021 (GU Serie Generale n.229 del 24-09-2021). https://www.gazzettaufficiale.it/eli/id/2021/09/24/21A05598/sg. Accessed September 2022.
Italian National Institute of Statistics (ISTAT). Rivaluta. https://rivaluta.istat.it. Accessed September 2022.
CCNL 2016-2018 del Comparto Sanità. https://www.aranagenzia.it/contrattazione/comparti/comparto-della-sanita/9016-ccnl-2016-2018-del-comparto-sanita.html. Accessed September 2022.
Agenzia Italiana del Farmaco (AIFA). Nota 79. https://www.aifa.gov.it/nota-79. Accessed September 2022.
Agenzia Italiana del Farmaco (AIFA). Nota 96. https://www.aifa.gov.it/Nota-96. Accessed September 2022.
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