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medpundit |
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Tuesday, September 17, 2002Although the recommendation to have a special x-ray every two to five years to check for osteoporosis may seem innocuous, it has a very serious potential to ratchet up the cost of healthcare even further without any evidence that it will improve overall health. The tests cost between $125 to $200 each. That means that if we follow the recommendations of the task force a woman (or more likely her insurance company) will have to spend $2,000 to be screened over the twenty year span that they recommend. As of 1999, there were about 17 million women in the US between the ages of 65 and 85, the age group in which screening is recommended. The cost of screening every woman in that group over the twenty year span would reach $34 billion, and that’s by 1999 population statistics. That number will only increase dramatically as the baby boomers age. Neither the effectiveness of osteoporosis screening nor its treatment have been established, as the Task Force freely admits: No controlled studies have evaluated the effect of screening on fractures or fracture-related morbidity. ...No randomized trial of treatment for osteoporosis has demonstrated an impact on mortality. ...There is little evidence regarding which patients are likely to benefit from screening and treatment. It is not known whether women who have a similar overall risk for fracture, but different bone densities, will benefit similarly from treatment. This uncertainty is clinically important because the lack of accepted criteria for initiating treatment remains a problem. As before, the Task Force relied on the dubious technique of meta-analysis to determine their recommendations, and they went even further by making statistical assumptions and projections based on the meta-analysis. Another caveat needs to be added in that we don’t know the long term consequences of taking the drugs we have to treat osteoporosis, although we do know the long term financial impact. Fosomax costs about $65 a month and can cause ulcers. It’s been on the market for the treatment of osteoporosis for about five years. We have no idea what kind of side effects it may have after twenty years of use. Estrogen is cheaper, can be had as a generic, and has been in longer use, but it was defamed last month by the Women’s Health Initiative study. Miacalcin is also expensive at $63 a month, probably safe, but not considered as effective as drugs like Fosamax. Evista, which is approved only for osteoporosis prevention but has hopes of being approved for treatment, costs $67 a month and again has only been in use for about five years. Of all of these, estrogen is the only drug that has even come close to being evaluated for long term use, and look what happened to it. With the Task Force coming out in favor of screening, the pressure will be on for insurance companies and Medicare to pay for it, for doctors to screen for it (to not do so could be perceived as providing inferior care), and then to subsequently treat it. The potential costs are staggering. The potential benefits are unknown. It’s disheartening to see the Task Force making recommendations such as this withhout fully considering the consequences. posted by Sydney on 9/17/2002 08:14:00 AM 0 comments 0 Comments: |
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