OBJECTIVES: We propose a six-step framework to extend conventional cost-effectiveness evaluation of novel technologies for an early health technology assessment of screening methods. We illustrate these steps by evaluating a novel screening method for fracture risk in community-dwelling older adults.

METHODS: Firstly, as in a conventional health economic evaluation, establish the context of the evaluation using the population, intervention, control and outcome (PICO) approach. Secondly, define the intervention(s) associated with screening test results. Thirdly, determine a willingness-to-pay threshold for the health outcome measured. Fourthly, use appropriate modelling techniques to calculate the Net Monetary Benefit across the sensitivities and false positive rates of the novel screening method and present them in a table. Fifthly, overlay the Receptor Operating Characteristics (ROC) curve of the novel screening method to determine the most optimal cutoff. Lastly, perform sensitivity analysis on model parameters to determine the key drivers and thresholds for cost effectiveness in novel screening methods.

RESULTS: We evaluated the use of a Finite Element Method (FEM) versus the Fracture Risk Assessment Tool (FRAX) in Singaporean older women (≥50 years old) to decide on bisphosphonates prescription to reduce morbidity, mortality, and healthcare costs associated with fractures. A Markov cohort simulation model was used to determine the QALYs and direct healthcare costs associated with fractures of the hip, wrist, vertebrae, and other sites over 50 years, from the healthcare payer perspective, at a WTP threshold of one time GDP per capita.

Assuming that FEM achieved a sensitivity of 0.71 and specificity of 0.63 as previously shown in a Canadian population, the use of FEM would generate a NMB of SGD$ 515 per older woman screened. This FEM screening method would be cost effective up to cost of SGD$ 407 per test.

CONCLUSIONS: Early HTA of FEM screening of Singaporean older women for fracture risk is cost effective.