TABLE II -.
Current costs for the diagnosis of osteoporosis
| REMS Mean (SD) | DXA Mean (SD) | REMS − DXA Mean (p-value) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Most conservative scenario (L) | Base-case scenario (M) | Least conservative c scenario (H) | Most onservative scenario (L) | Base-case scenario (M) | Least conservative scenario (H) | Most conservative scenario (L) | Base-case scenario (M) | Least conservative scenario (H) | |
| Personnel | |||||||||
| Clinician | €13.9 (9.4) | €25.5 (11.1) | €48.3 (27.1) | €14.5 (12) | €23.4 (16.1) | €40.4 (24.4) | −€0.6 (n.s.) | €0.6 (n.s.) | €7.9 (n.s.) |
| Nurse | €1.3 (2.8) | €1.4 (3.3) | €2.2 (4.7) | €2.3 (3.4) | €2.8 (3.7) | €4.0 (4.7) | −€1.0 (n.s.) | −€1.4 (n.s.) | −€1.8 (n.s.) |
| Radiology technician | €0.8 (1.7) | €1.7 (3.3) | €2.5 (4.8) | €8.2 (4.2) | €11.7 (5.6) | €17.6 (6.2) | −€7.3 (<0.001) | −€9.9 (<0.001) | −€15.1 (<0.001) |
| Resident | €0.7 (2.0) | €1.8 (3.2) | €3.6 (7.3) | €1.9 (3.7) | €3.5 (5.3) | €5.3 (7.5) | −€1.2 (n.s.) | −€1.6 (n.s.) | −€1.8 (n.s.) |
| Other healthcare personnel | €0.0 (0.0) | €0.1 (0.4) | €0.2 (0.8) | €0.4 (1.0) | €0.9 (2.3) | €2.9 (8.3) | −€0.4 (n.s.) | −€0.8 (n.s.) | −€2.7 (n.s.) |
| Administrative staff | €0.8 (1.2) | €1.3 (1.9) | €2.4 (2.6) | €2.4 (2.6) | €6.6 (7.1) | €17.5 (27.4) | −€1.5 (n.s.) | −€5.3 (0.018) | −€15.1 (n.s.) |
| Total personnel | €17.6 (12.1) | €31.9 (12.3) | €59.3 (30.1) | €29.6 (21) | €48.8 (23.1) | €87.8 (43) | −€12.0 (n.s.) | −€16.9 (0.034) | −€28.5 (n.s.) |
| Instrumental exams | |||||||||
| CT scan | €1.2 (4.3) | €2.2 (4.6) | €8.5 (21.5) | €5.1 (9.7) | €8.8 (16.3) | €19 (29.5) | −€3.9 (n.s.) | −€6.6 (n.s.) | −€10.4 (n.s.) |
| Magnetic resonance | €2.9 (5.0) | €5.0 (7.7) | €15.2 (32.1) | €8.1 (12.9) | €13.3 (18.7) | €27.8 (37.6) | −€5.2 (n.s.) | −€8.3 (n.s.) | −€12.6 (n.s.) |
| X-ray of the dorsal-lumbar spine | €5.5 (8.6) | €7.4 (8.5) | €11.6 (13.1) | €7.8 (8.4) | €11.6 (8.6) | €17.6 (12.6) | −€2.3 (n.s.) | −€4.2 (n.s.) | −€6 (n.s.) |
| Laboratory tests − I level | |||||||||
| 24-hour urinary calcium | €0.3 (0.3) | €0.4 (0.4) | €0.6 (0.4) | €0.4 (0.4) | €0.4 (0.4) | €0.7 (0.4) | €0.0 (n.s.) | €0.0 (n.s.) | −€0.2 (n.s.) |
| Alkaline phosphatase (ALP) | €0.4 (0.4) | €0.4 (0.4) | €0.6 (0.5) | €0.5 (0.5) | €0.5 (0.5) | €0.8 (0.4) | −€0.1 (n.s.) | −€0.1 (n.s.) | −€0.2 (n.s.) |
| Calcemia | €0.5 (0.5) | €0.6 (0.5) | €0.7 (0.5) | €0.6 (0.6) | €0.7 (0.6) | €0.9 (0.5) | −€0.2 (n.s.) | −€0.1 (n.s.) | −€0.2 (n.s.) |
| Complete blood count | €1.0 (1.5) | €1.1 (1.5) | €1.4 (1.5) | €1.1 (1.4) | €1.3 (1.4) | €1.9 (1.4) | −€0.2 (n.s.) | −€0.2 (n.s.) | −€0.5 (n.s.) |
| Creatininemia | €0.4 (0.5) | €0.5 (0.5) | €0.6 (0.5) | €0.6 (0.5) | €0.6 (0.5) | €0.8 (0.5) | −€0.1 (n.s.) | −€0.1 (n.s.) | −€0.2 (n.s.) |
| Erythrocyte sedimentation rate (ESR) | €0.5 (0.8) | €0.6 (0.8) | €0.9 (0.9) | €0.6 (0.8) | €0.7 (0.8) | €1.1 (0.9) | −€0.1 (n.s.) | −€0.1 (n.s.) | −€0.2 (n.s.) |
| Phosphorus | €0.6 (0.6) | €0.7 (0.6) | €0.8 (0.6) | €0.7 (0.7) | €0.8 (0.7) | €1.1 (0.6) | −€0.1 (n.s.) | −€0.1 (n.s.) | −€0.2 (n.s.) |
| Protidemia (fraction) | €1.3 (2.0) | €1.5 (1.9) | €2 (1.9) | €1.6 (1.9) | €1.8 (1.8) | €2.7 (1.8) | −€0.3 (n.s.) | −€0.3 (n.s.) | −€0.8 (n.s.) |
| Laboratory tests − II level | |||||||||
| Ionized calcium | €0.2 (0.3) | €0.3 (0.4) | €0.4 (0.5) | €0.2 (0.4) | €0.3 (0.4) | €0.5 (0.5) | €0.0 (n.s.) | €0.0 (n.s.) | −€0.2 (n.s.) |
| Thyroid-stimulating hormone (TSH) | €1.0 (1.8) | €1.2 (1.8) | €1.8 (2.2) | €1.2 (2.1) | €1.4 (2.1) | €2.4 (2.3) | −€0.2 (n.s.) | −€0.1 (n.s.) | −€0.6 (n.s.) |
| Parathyroid hormone (PTH) | €5.8 (7.6) | €7.5 (7.7) | €10.3 (8) | €7.1 (8.3) | €8.5 (8.5) | €12.8 (8.2) | −€1.3 (n.s.) | −€1.1 (n.s.) | −€2.5 (n.s.) |
| 25-Hydroxy vitamin D | €7.1 (6.7) | €8.4 (6.4) | €11.7 (5.7) | €7.6 (7.5) | €8.5 (7.4) | €12 (6.5) | −€0.5 (n.s.) | −€0.1 (n.s.) | −€0.3 (n.s.) |
| Overnight dexamethasone suppression test | €0.6 (1.5) | €0.9 (1.7) | €1.7 (2.7) | €0.7 (1.7) | €1.2 (2.0) | €2.8 (3.2) | €0.0 (n.s.) | −€0.3 (n.s.) | −€1.1 (n.s.) |
| Serum immunofixation | €1.9 (4.2) | €2.7 (5) | €4.7 (7.5) | €2.5 (5.8) | €3.5 (6) | €7.7 (8.6) | −€0.7 (n.s.) | −€0.8 (n.s.) | −€3.0 (n.s.) |
| Urine immunofixation | €1.4 (3.4) | €2.1 (4.0) | €4.0 (6.9) | €1.5 (3.2) | €2.5 (3.8) | €6.9 (7.9) | −€0.1 (n.s.) | −€0.4 (n.s.) | −€2.9 (n.s.) |
| Anti-transglutaminase antibodies (ATA) | €1.4 (3.0) | €1.8 (3.1) | €2.9 (3.8) | €1.7 (3.3) | €1.9 (3.2) | €3.9 (4.1) | −€0.2 (n.s.) | −€0.1 (n.s.) | −€1.0 (n.s.) |
| Total exams | €34 (41.3) | €45.1 (45.2) | €80.5 (93.6) | €49.6 (58.1) | €68.2 (72.1) | €123.6 (108.3) | −€15.6 (n.s.) | −€23.1 (n.s.) | −€43.0 (n.s.) |
CT = computed tomography; DXA = dual-energy X-ray absorptiometry; n.s. = not significant; REMS = Radiofrequency Echographic Multi Spectrometry; SD = standard deviation.