Comparison of screening strategies for prevalent vertebral fractures in South Korea: vertebral fracture assessment vs. spine radiography

Table 1 Summary of the input parameters in the model for base case analysis and univariate sensitivity analysis

Parameter	Value^a		Sources	Note
Parameter	Women	Men	Sources	Note
Probabilities
VF prevalence	0.22 [0.08]	0.11 [0.03]	HIRA, [17, 18]	NHI database [Community-based cohort]
two-year VF incidence	0.12 [0.13]	0.05 [0.05]	HIRA, [32]	NHI database [Community-based cohort]
two-year new VF incidence	0.22 [0.23]	0.22 [0.23]	[19, 32]	Hospital cohort- NHI database linked data [Community-based cohort]
RR of new VF on drug therapy	0.58 [0.64]	0.38 [0.41]	[19, 23,24,25,26]	Meta-analysis literature review, pooled RR [decrease by 10%]
Diagnostic accuracy
Sensitivity of X-ray	1.00	1.00		Gold standard
Specificity of X-ray	1.00	1.00		Gold standard
Sensitivity of VFA	0.82 [0.74]	0.82 [0.74]	[22]	SR [95% CI lower limit, conservative]
Specificity of VFA	0.93 [0.89]	0.93 [0.89]	[22]	SR [95% CI lower limit, conservative]
VFA impossible	0.03 [0.05]	0.03 [0.05]	[22]	SR, per patient [per vertebrae]
Costs (€)^b
VFA^c	17 [40]	17 [40]	[27]	50% of X-ray test costs [Increase by 200% of X-ray costs, conservative]
X-ray^c	24 [17]	24 [17]	HIRA	EDI code, thoracic and lumbar spine in the AP and lateral
VFs treatment	1526 [1249]	1707 [1336]	HIRA	NHI database, per patient [Mild VF relatively]
Physician visits	9	9	HIRA	NHI database, per visit
Drug therapy	180	194	HIRA	Drug weighted average charge, one-year administration
Procedure	809	934	HIRA	NHI database, only in symptomatic VF cases
Radiation doses (μSv)
X-ray	600	600	[12]
VFA	25 [2]	25 [2]	[12]	Average level of 2 to 50 μSv [lower limit]

VF vertebral fracture, HIRA Health Insurance Review and Assessment Service, NHI National Health Insurance, RR relative risk, AP anterior-posterior, VFA vertebral fracture assessment, SR systematic review
^aValue in brackets, []: Inputs data for univariate sensitivity analysis
^bKorean won converted to euros (€) using an exchange rate of 1€ = 1482 KRW (2013)
^cVFA and X-ray costs included the test and a physician visit

ISSN: 1471-2474