OBJECTIVES: General practitioners prescribe antiosteoporotic treatments to elderly women in spite of the lack of cost-effectiveness evidence. Our goal was to assess cost-effectiveness of primary prevention of osteoporotic hip fractures through opportunistic risk-based screening in elderly women at primary care.

METHODS: A discrete event simulation model was built to evaluate osteoporotic opportunistic screening in primary care in women aged 70 to 89 years. Screening was based on a fracture risk score. Diet recommendations were considered for low risk women and osteoporotic treatment for high risk women. For intermediate risk women, treatment decision was based on a recalculated risk score that included bone mineral density (BMD). Risk assessments were performed biennially and the model accounted for costs of visits, BMD and treatments. The time until hip fracture was conditioned on osteoporosis presence. Occurrence of hip fracture changed the risk of death. Costs of acute and long-term care were included. Cost-effectiveness was analyzed from the societal. Several cut-points for the risk of fracture were tested. Sensitivity analysis was performed for the most cost-effective cut-points. Time horizon was 20 years.

RESULTS: A random sample of 3000 real women were included in the model. The most cost-effective preventive intervention had an ICER of 111,310€ per avoided fracture. This corresponded to cut-off points of less than 3.5% for low risk women, more than 5.5% for high risk women and 4% for intermediate risk women. A 90% of simulations were cost-effective at a threshold of 280,000€. Sensitivity analysis based on the time until fracture, treatment effectiveness, adherence to treatment and cost of dependence resulted in ICER ranging from 60,111€ to 265,753€.

CONCLUSIONS: Primary prevention of osteoporotic hip fractures through opportunistic risk-based screening in elderly women at primary care was not cost-effective. General practitioners should be persuaded of prescribing such treatments to women without previous osteoporotic fracture.