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Long-term cost-effectiveness of screening for fracture risk in a UK primary care setting: the SCOOP study

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Abstract

Summary

Community-based screening and treatment of women aged 70–85 years at high fracture risk reduced fractures; moreover, the screening programme was cost-saving. The results support a case for a screening programme of fracture risk in older women in the UK.

Introduction

The SCOOP (screening for prevention of fractures in older women) randomized controlled trial investigated whether community-based screening could reduce fractures in women aged 70–85 years. The objective of this study was to estimate the long-term cost-effectiveness of screening for fracture risk in a UK primary care setting compared with usual management, based on the SCOOP study.

Methods

A health economic Markov model was used to predict the life-time consequences in terms of costs and quality of life of the screening programme compared with the control arm. The model was populated with costs related to drugs, administration and screening intervention derived from the SCOOP study. Fracture risk reduction in the screening arm compared with the usual management arm was derived from SCOOP. Modelled fracture risk corresponded to the risk observed in SCOOP.

Results

Screening of 1000 patients saved 9 hip fractures and 20 non-hip fractures over the remaining lifetime (mean 14 years) compared with usual management. In total, the screening arm saved costs (£286) and gained 0.015 QALYs/patient in comparison with usual management arm.

Conclusions

This analysis suggests that a screening programme of fracture risk in older women in the UK would gain quality of life and life years, and reduce fracture costs to more than offset the cost of running the programme.

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Acknowledgments

Ethical approval was obtained from the North Western - Haydock Research Ethics Committee of England in September 2007 (REC 07/H1010/70). The trial was registered on the International Standard Randomized Controlled Trial Register in June 2007 (ISRCTN 55814835). The Arthritis Research United Kingdom (ARUK), formerly the Arthritis Research Campaign (ARC), and the Medical Research Council (MRC) of the UK jointly funded this trial.

Other SCOOP Study Team members:

Bristol: Ali Heawood. Birmingham: Nicola Crabtree, Helen Duffy, Neil Gittoes, Jim Parle, Farzana Rashid, Katie Stant. Bristol: Kate Taylor, Clare Thomas (née Emmett). Manchester: Emma Knox, Cherry Tenneson, Helen Williams. Norwich: David Adams, Veronica Bion, Jeanette Blacklock, Tony Dyer, Rebekah Fong-Soe-Khioe, Elizabeth Lenaghan. Sheffield: Selina Bratherton (née Simpson), Matt Fidler, Katharine Knight, Carol McGurk, Katie Smith, Stacey Young. Southampton: Karen Collins, Janet Cushnaghan. York: Catherine Arundel, Kerry Bell, Laura Clark, Sue Collins, Sarah Gardner, Natasha Mitchell, David Torgeson.

Disclosures

C Cooper has received consultancy fees and honoraria from Amgen, Danone, Eli Lilly, GlaxoSmithKline, Medtronic, Merck, Nestlé, Novartis, Pfzer, Roche, Servier, Shire, Takeda, and UCB. N Harvey has received consultancy, lecture fees, and honoraria from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Servier, Shire, UCB, Consilient Healthcare, and Internis Pharma JA Kanis reports grants from UCB, Amgen and Radius Health outside the submitted work. E McCloskey has been, or currently is, an adviser or speaker for and has received research support from ActiveSignal, Amgen, AstraZeneca, Consilient Healthcare, GlaxoSmithKline, Hologic, Internis, Eli Lilly, Medtronic, Merck, Novartis, Pfzer, Roche, Sanof-Aventis, Servier, Synexus, Tethys, UCB, and Warner Chilcott; and has received research support from I3 Innovus, International Osteoporosis Foundation, and Unilever. E Söreskog and F Borgström have previously consulted for companies marketing products for osteoporosis. T O’Neill has received consultancy fees from UCB and research support from Amgen outside the submitted work.

S Clarke, I Harvey, R Holland, A Howe, H Johansson, T Marshall, T Peters, N Redmond, L Shepstone have nothing to disclose.

Author information

Authors and Affiliations

  1. Quantify Research, Stockholm, Sweden

    E. Söreskog & F. Borgström

  2. LIME/MMC, Karolinska Institutet, Stockholm, Sweden

    F. Borgström

  3. Norwich Medical School, University of East Anglia, Norwich, UK

    L. Shepstone, I. Harvey, A. Howe & D. Turner

  4. Department of Rheumatology, University Hospitals Bristol, Bristol, UK

    S. Clarke

  5. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

    C. Cooper & N. C. Harvey

  6. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

    C. Cooper & N. C. Harvey

  7. Oxford Biomedical Research Unit, University of Oxford, Oxford, UK

    C. Cooper

  8. Centre for Metabolic Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK

    H. Johansson, E. McCloskey & J. A. Kanis

  9. Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    H. Johansson

  10. Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia

    H. Johansson & J. A. Kanis

  11. Norfolk and Norwich University Hospital, Norwich, UK

    T. Marshall

  12. NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK

    T. W. O’Neill

  13. Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK

    T. W. O’Neill

  14. Bristol Medical School, University of Bristol, Bristol, UK

    T. J. Peters & N. M. Redmond

  15. National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation, Bristol, UK

    N. M. Redmond

  16. Leicester Medical School, Centre for Medicine, University of Leicester, Leicester, UK

    R. Holland

  17. Centre for Integrated research into Musculoskeletal Ageing, University of Sheffield Medical School, Sheffield, UK

    E. McCloskey

  18. Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK

    E. McCloskey

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  1. E. Söreskog
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  2. F. Borgström
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  4. S. Clarke
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  17. J. A. Kanis
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Consortia

SCOOP study team

  • A. Heawood
  • , N. Crabtree
  • , H. Duffy
  • , N. Gittoes
  • , J. Parle
  • , F. Rashid
  • , K. Stant
  • , K. Taylor
  • , C. Thomas
  • , E. Knox
  • , C. Tenneson
  • , H. Williams
  • , D. Adams
  • , V. Bion
  • , J. Blacklock
  • , T. Dyer
  • , R. Fong-Soe-Khioe
  • , E. Lenaghan
  • , S. Bratherton
  • , M. Fidler
  • , K. Knight
  • , C. McGurk
  • , K. Smith
  • , S. Young
  • , K. Collins
  • , J. Cushnaghan
  • , C. Arundel
  • , K. Bell
  • , L. Clark
  • , S. Collins
  • , S. Gardner
  • , N. Mitchell
  •  & D. Torgeson

Corresponding author

Correspondence to J. A. Kanis.

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Söreskog, E., Borgström, F., Shepstone, L. et al. Long-term cost-effectiveness of screening for fracture risk in a UK primary care setting: the SCOOP study. Osteoporos Int 31, 1499–1506 (2020). https://doi.org/10.1007/s00198-020-05372-6

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