Cost-effectiveness of radiofrequency echographic multi-spectrometry for the diagnosis of osteoporosis in the United States

Radiofrequency echographic multi-spectrometry (REMS) is an innovative, non-ionizing diagnostic technique that has shown high accuracy and precision, making it a promising alternative to DXA for osteoporosis diagnosis in clinical settings. With economic considerations playing an increasingly crucial role in healthcare decisions, this study aims to evaluate the cost-effectiveness and economic impact of improved osteoporosis diagnosis using REMS followed by treatment in the United States. A microsimulation-based Markov model was constructed to estimate the cost per quality-adjusted life year (QALY) gained (in US$2022) for REMS followed by treatment vs no diagnosis and treatment in US women aged 50 yr and older with osteoporosis. Women were categorized as high risk (receiving alendronate monotherapy for 5 yr) or very high risk (receiving an 18-mo course of anabolic treatment, abaloparatide, followed by 5 yr of alendronate). The study evaluated 2 medication adherence scenarios: one assuming full adherence to treatment and the other reflecting real-world adherence. The results indicate that REMS followed by treatment is associated with improved health outcomes, including more QALYs and fewer fractures, and reduced fracture-related costs compared to no diagnosis and treatment. The incremental cost-effectiveness ratio of REMS was estimated at $33 891 and $49 198 per QALY gained, under the full adherence and real-world adherence scenarios, respectively. These values are below the US cost-effectiveness threshold of $100 000 per QALY. Moreover, a 5% increase in the diagnosis and treatment of women over 50 yr at high and very high risk of fractures using REMS is projected to save approximately 30 000 life yr, 43 500 QALYs, and prevent 100 000 fractures over a lifetime under real-world medication adherence. In conclusion, this study suggests that REMS is a cost-effective strategy for the diagnosis and management of osteoporosis in US women, offering substantial potential economic benefits and improved health outcomes. Osteoporosis remains largely underdiagnosed and undertreated, with about three-quarters of at-risk individuals not receiving treatment. While DXA is the standard for assessing BMD, it has limitations like limited accessibility and radiation exposure. Radiofrequency echographic multi-spectrometry (REMS) offers a portable, radiation-free alternative with accuracy comparable to DXA. This study used an economic model to assess the cost-effectiveness of REMS followed by treatment compared to no diagnosis. Results indicate that REMS is cost-effective and could prevent over 100 000 fractures over a lifetime if an additional 5% of at-risk patients in the United States are detected and treated.