ABSTRACT
Objetivo. En España, el estudio FRIDEX ha aportado recientemente unos umbrales de riesgo coste-efectivos para el manejo de la osteoporosis. El objetivo del estudio es evaluar el impacto de su aplicación en la práctica clínica habitual, comparándola también con los umbrales de la National Osteoporosis Guidelines Group (NOGG). Material y métodos. Estudio transversal realizado en mujeres remitidas a una unidad de densitometría ósea. El riesgo absoluto de presentar una fractura mayor o de cadera se calculó mediante la fórmula FRAX® española y británica para poder emplear los umbrales de intervención de la calibración FRIDEX y de la guía NOGG, respectivamente. Se descartaron mujeres con tratamiento antirresortivo. Resultados. Fueron incluidas 607 mujeres con una mediana de edad de 59,4 (RIQ=14) años. El 31,4% recibieron tratamiento después de la densitometría ósea. El empleo de la calibración FRIDEX indicaría una densitometría ósea al 35,4% y tratamiento al 26,7%, lo que supondría una reducción de gastos a los 5años del 18,8%. Según la guía NOGG precisarían densitometría ósea el 32% y tratamiento el 21,3%, siendo el ahorro de un 35% a los 5años respeto a la actitud habitual. La concordancia de la guía NOGG y del FRIDEX según el coeficiente kappa de Cohen fue baja tanto a nivel diagnóstico (0,16 [IC95%: 0,09-0,24]) como terapéutico (0,39 [IC95%: 0,31-0,47]). Conclusiones. La aplicación de la calibración FRIDEX y de la guía NOGG aumentaría la eficiencia del manejo de la osteoporosis, aunque su concordancia es baja, indicando tratamiento en diferentes perfiles de mujeres (AU)
Objective. The recent FRIDEX calibration proposed cost-effectiveness thresholds for the Spanish population. The aim of our study is to evaluate the impact of its application in routine clinical practice and to compare its thresholds with those of the National Osteoporosis Guideline Group (NOGG). Material and methods. Cross-sectional study in women referred to a bone densitometry unit who were not receiving antiresorptive therapy. The absolute risk of major fracture or hip fracture was calculated with the Spanish and British formulas of the FRAX® tool using the intervention thresholds of the FRIDEX calibration and the NOGG guideline, respectively. Results. The study included 607 women with a median age of 59.4 (IQR=14) years. Treatment was initiated in 31.4% after bone mineral densitometry. With the application of the FRIDEX calibration, bone mineral density testing would have been indicated in 35.4% of the sample and treatment in 26.7%, reducing costs by 18.8% over a 5-year period. The NOGG guideline would have recommended testing in 32% and treatment in 21.3% of the participants, resulting in a reduction in costs of 35% over 5years, when compared with the standard approach. Agreement between the FRIDEX calibration and the NOGG guideline, as defined by Cohen's kappa coefficient, was low in terms of both diagnostic (0.16 [95%CI, 0.09-0.24]) and therapeutic indications (0.39 [95%CI, 0.31-0.47]). Conclusions. The application of the FRIDEX calibration and the NOGG guideline improves efficiency in the management of osteoporosis, although the level of agreement between the two is low (AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Osteoporosis/therapy , Osteoporosis , Osteoporosis/economics , Calibration/standards , Cost Efficiency Analysis , Cross-Sectional Studies/methods , Densitometry/methods , Cohort Studies , Cost-Benefit Analysis/organization & administration , Cost-Benefit Analysis/standardsABSTRACT
OBJECTIVE: The recent FRIDEX calibration proposed cost-effectiveness thresholds for the Spanish population. The aim of our study is to evaluate the impact of its application in routine clinical practice and to compare its thresholds with those of the National Osteoporosis Guideline Group (NOGG). MATERIAL AND METHODS: Cross-sectional study in women referred to a bone densitometry unit who were not receiving antiresorptive therapy. The absolute risk of major fracture or hip fracture was calculated with the Spanish and British formulas of the FRAX® tool using the intervention thresholds of the FRIDEX calibration and the NOGG guideline, respectively. RESULTS: The study included 607 women with a median age of 59.4 (IQR=14) years. Treatment was initiated in 31.4% after bone mineral densitometry. With the application of the FRIDEX calibration, bone mineral density testing would have been indicated in 35.4% of the sample and treatment in 26.7%, reducing costs by 18.8% over a 5-year period. The NOGG guideline would have recommended testing in 32% and treatment in 21.3% of the participants, resulting in a reduction in costs of 35% over 5years, when compared with the standard approach. Agreement between the FRIDEX calibration and the NOGG guideline, as defined by Cohen's kappa coefficient, was low in terms of both diagnostic (0.16 [95%CI, 0.09-0.24]) and therapeutic indications (0.39 [95%CI, 0.31-0.47]). CONCLUSIONS: The application of the FRIDEX calibration and the NOGG guideline improves efficiency in the management of osteoporosis, although the level of agreement between the two is low.
