Article (Scientific journals)
Evaluation of proposals of Belgian Social Security Institute for reimbursement of bone densitometry tests. Toward a cost-effective strategy for osteoporosis screening?
Ben Sedrine, Wafa; Ethgen, Olivier; Devogelaer, Jean-Pierre et al.
2004In Aging Clinical and Experimental Research, 16 (5), p. 413-419
Peer Reviewed verified by ORBi
 

Files


Full Text
20120315150301593.pdf
Publisher postprint (699.1 kB)
Request a copy

All documents in ORBi are protected by a user license.

Send to



Details



Keywords :
Absorptiometry, Photon/economics; Aged; Aged, 80 and over; Belgium; Bone Density; Cost-Benefit Analysis; Female; Government Agencies; Humans; Mass Screening/economics/methods; Middle Aged; Osteoporosis/diagnosis/economics; Osteoporosis, Postmenopausal/diagnosis/economics; Reimbursement Mechanisms; Risk Factors
Abstract :
[en] BACKGROUND AND AIMS: The Belgian Social Security Institute (hereafter INAMI) proposes a list of conditions to be considered as a prerequisite for reimbursement of Bone Mineral Density (BMD) measurements. The aim of this paper was to evaluate the diagnostic accuracy of the proposed criteria for identifying osteoporosis, and to gauge how useful they are for more rational application of densitometry tests. METHODS: 3748 Caucasian women aged at least 50 years old were recruited consecutively from an outpatient university center, from the database of which all relevant data corresponding to the INAMI list of clinical factors, as well as patients' age, weight and height, were collected. BMD measurements using dual X-ray absorptiometry were reported at the spine and hip regions. Diagnostic accuracy was evaluated through measures of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Additionally, from ROC analysis, benchmark values for age and body mass index were identified and then, used alone and in combination with the INAMI test, were applied to define various screening strategies. For each of them, associated costs per osteoporotic patient detected were estimated. Cost estimates refer only to the costs associated with the densitometric procedure from the perspective of the reimbursement health authorities. RESULTS: Applying INAMI criteria for detecting osteoporosis at any of the considered sites yielded sensitivity of 68.9%, specificity of 50.7%, PPV of 42.9% and NPV of 57.3%. Comparison of incremental costs per patient of the different strategies revealed that, with 67.1 Euros, the option of opening BMD coverage to women on the basis of the INAMI conditions would be more cost-effective than mass screening (90.1 Euros) or applying the age criterion alone (70.2 Euros). However, the BMI condition seems to act as a better indicator of risk than the INAMI criteria in those meeting the age condition (35.4 Euros). CONCLUSIONS: The accuracy of the INAMI proposal turns out to be quite unsatisfactory, and did not adequately cover the population at risk of osteoporosis. From a resource allocation perspective, the best strategy by far would be to recommend using concomitantly INAMI, age and BMI-selective criteria. Some adaptations could enhance the usefulness of the INAMI proposals as a selective approach for BMD referral and reimbursement.
Disciplines :
Public health, health care sciences & services
Special economic topics (health, labor, transportation...)
Author, co-author :
Ben Sedrine, Wafa ;  Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Ethgen, Olivier ;  Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique : aspects spécifiques
Devogelaer, Jean-Pierre
Depresseux, Genevieve
Kaufman, Jean-Marc
Goemaere, Stefan
Reginster, Jean-Yves  ;  Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Language :
English
Title :
Evaluation of proposals of Belgian Social Security Institute for reimbursement of bone densitometry tests. Toward a cost-effective strategy for osteoporosis screening?
Publication date :
2004
Journal title :
Aging Clinical and Experimental Research
ISSN :
1594-0667
eISSN :
1720-8319
Publisher :
Editrice Kurtis SRL, Milano, Italy
Volume :
16
Issue :
5
Pages :
413-419
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 30 March 2012

Statistics


Number of views
147 (1 by ULiège)
Number of downloads
0 (0 by ULiège)

Scopus citations®
 
2
Scopus citations®
without self-citations
1
OpenCitations
 
1

Bibliography


Similar publications



Contact ORBi