Using Dental Imaging to Identify Women At-Risk of Osteoporosis: A Cost-Effectiveness Analysis

Abstract: Introduction: Osteoporosis is a term for “porous bone” and is seen as a major health problem due to the high costs of treating osteoporosis-related fractures, which often are the first signs of the disease. A wide range of studies have shown the possibility of identifying changes in the structure and density of the jaw bone tissue that are associated with osteoporosis through dental images. Aim: The aim was to investigate, by means of an economic decision model, whether a new method (NM) for osteoporosis risk assessment in primary dental care is associated with a smaller number of osteoporotic fractures and lower costs compared with the conventional method (CM) for diagnosing osteoporosis using DXA measurements. Material and Method: A simulated cohort of all women at the age of ≥ 50 years in Kalmar County was followed for 34 years. The model is based on cost-data retrieved from Kalmar County hospital and Västervik hospital, from an on-going study at Kalmar County hospital as well as from published literature. All relevant direct costs associated with NM and CM were identified, measured and valued resulting in a total cost per patient and osteoporotic fracture that was incorporated in the model. Results: The model showed that the estimated number of fractures during the remaining statistical lifetime of the women, i.e. 34 years from the age of 50, was considerably lower for NM with n=4 699 for NM compared with n=23 712 for CM. Also the total direct lifetime cost for NM was considerably lower with 1 billion € compared with 5.1 billion € for CM resulting in an incremental cost of 4.1 billion €. The direct cost to the provider was 1 003 911 114 € for NM and 5 060 551 385 € for CM whereas the cost related to the patient was 813 966 € for NM and 622 689 € for CM. The incremental cost-effectiveness ratio (ICER) was negative showing a 213 363 € lower cost per fracture for NM compared with CM. Hence, NM was dominant and unequivocally cost-effective compared with CM. Conclusion: This model-analysis suggests that the NM using risk-assessment of osteoporosis in primary dental care is a cost-effective method compared with the CM of diagnosing osteoporosis. Using this NM can lead to a reduced number of undetected osteoporosis cases and osteoporosis-related fractures which in turn can result in an increased quality of life among women aged 50 years and upwards as well as a reduced financial burden for the healthcare system and for society.