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Rival osteoporosis guideline to NICE would save money

By Lilian Anekwe

Substantial cost savings would be made if a primary care osteoporosis guideline – drawn up to rival controversial NICE advice – was adopted, say researchers.

Using the FRAX risk assessment tool recommended by the National Osteoporosis Group Guideline (NOGG) to screen and treat patients at risk of osteoporosis results in treatment costs that fall ‘comfortably' within cost-effectiveness thresholds set by NICE.

The guidance, launched last October by 10 medical organisations including the National Osteoporosis Society and the Primary Care Rheumatology Society, contradicts NICE in endorsing the use of the FRAX risk score to identify patients for primary prevention, and in recommending all post-menopausal women be considered for secondary prevention after a fracture.

A cost effectiveness analysis found that applying the NOGG guidance to 1,180 patients aged 53 to 106 at a practice in Northumbria found 38 patients needed treatment and 393 required a DXA scan.

Assuming a standard tariff cost for DXA scanning of £40 per scan and extrapolating it to a population of 100,000 over five years, the researchers estimated net savings of £600,000 over a five year period compared to existing rates under NICE guidance.

The research was presented at the British Society for Rheumatology conference this month.

Dr Fraser Birrell, co-author and a consultant in rheumatology at the Northumbria Healthcare NHS foundation trust, said: ‘NICE guidance has its strengths and it has its weaknesses. At present even people who are at the highest risk of osteoporosis still are not getting the right treatment.

‘What the widespread availability of the NOGG guidance has allowed us to do is quantify the number of people requiring DXA scans. There's no doubt that using the NOGG guidance satisfies the £20,000 per quality-adjusted life year criteria comfortably.'

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