Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Đánh giá hiệu quả chi phí của siêu âm và densitometry xương trong sàng lọc loãng xương ở phụ nữ sau mãn kinh
Tóm tắt
Theo một hướng dẫn mới của Đức, quyết định về điều trị bisphosphonate cho phụ nữ sau mãn kinh nên được dựa trên nguy cơ gãy xương trong 10 năm, và mật độ xương nên được đo bằng phương pháp hấp thụ tia X hai lần (DXA). Gần đây, đã có sự quan tâm ngày càng tăng đối với siêu âm định lượng (QUS) như một giải pháp sàng lọc ít tốn kém hơn. Nghiên cứu này nhằm xác định tính hiệu quả về chi phí của việc sàng lọc loãng xương bằng QUS như một bài test trước khi thực hiện DXA và điều trị bằng alendronate so với (i) truy cập ngay lập tức vào DXA và (ii) không sàng lọc ở phụ nữ trong dân số chung từ 50-90 tuổi tại Đức. Một phân tích chi phí - tiện ích và một phân tích tác động ngân sách đã được thực hiện từ góc độ của bảo hiểm y tế nhà nước (SHI). Một mô hình Markov với chu kỳ dài 1 năm được sử dụng để mô phỏng chi phí và lợi ích (QALYs), được chiết khấu ở mức 3% mỗi năm, trong suốt cuộc đời. Số lượng phụ nữ được chẩn đoán đúng bằng QUS và DXA có nguy cơ gãy xương trong 10 năm ≥30% đã được ước tính cho các nhóm tuổi khác nhau (50-60, 60-70, 70-80 và 80-90 tuổi, tương ứng). Tính ổn định của các kết quả đã được kiểm tra bằng mô phỏng Monte Carlo xác suất. So với không sàng lọc, tính hiệu quả về chi phí của QUS cộng với DXA được tìm thấy là €3529, €9983, €4382 và €1987 cho các phụ nữ 50-, 60-, 70- và 80 tuổi, tương ứng (giá trị năm 2006). Chiến lược sàng lọc này dẫn đến chi phí hàng năm là €96 triệu hoặc 0.07% tổng ngân sách hàng năm của SHI. Tính hiệu quả về chi phí của DXA đơn độc so với DXA cộng với QUS là €5331, €60804, €14943 và €3654 cho các phụ nữ 50-, 60-, 70- và 80 tuổi, tương ứng. DXA đơn độc dẫn đến số lượng QALYs cao hơn ở tất cả các nhóm tuổi. Các kết quả cũng được chứng minh là ổn định trong phân tích độ nhạy. So với không sàng lọc, tính hiệu quả về chi phí của QUS và DXA theo thứ tự rất thuận lợi ở tất cả các nhóm tuổi. Tuy nhiên, truy cập trực tiếp vào DXA cũng là một lựa chọn hiệu quả về chi phí, vì nó làm tăng số lượng QALYs với một chi phí chấp nhận được so với việc thử nghiệm trước bằng QUS (trừ phụ nữ trong độ tuổi 60-70). Do đó, QUS như một bài test trước khi thực hiện DXA chỉ có thể được khuyến nghị rõ ràng cho phụ nữ trong độ tuổi 60-70. Đối với các nhóm tuổi khác, tính hiệu quả về chi phí của QUS như một bài test trước phụ thuộc vào giới hạn ngân sách toàn cầu và khả năng tiếp cận DXA.
Từ khóa
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