Cost-effectiveness of osteoporotic fracture risk assessment in people with intellectual disabilities: a UK NHS modelling study

Clinical Snapshot

Key Findings

• P Value: Not applicable for economic evaluation

• Effect Size: IDFracture strategy dominant for major osteoporotic fractures

• Primary Outcome: Incremental cost-effectiveness ratios for fracture risk assessment strategies

• Nnt Or Sensitivity: ICER: -£2568/QALY (dominant) for IDFracture vs QFracture for major osteoporotic fractures

• Confidence Interval: Not reported in abstract

Clinical Application

Requires implementation of IDFracture tool and coordinated care pathways for ID population Highly relevant to Australian healthcare system with similar screening approaches, PBS subsidised bisphosphonates, and Medicare-funded DXA scans. RACGP guidelines for osteoporosis screening could incorporate ID-specific considerations Adults with intellectual disabilities aged ≥40 years in primary care settings

Abstract

OBJECTIVES: We compared the cost-effectiveness of alternative fracture risk assessment strategies for people with intellectual disabilities (ID) aged ≥40 years from a UK National Health Services perspective over a lifetime horizon. DESIGN: Cost-effectiveness analysis using a lifetime decision-analytical model. SETTING: UK primary care, with data from literature and national databases. PARTICIPANTS: People with ID. INTERVENTIONS: Three strategies were assessed: (S1) Risk assessment using the UK QFracture score; (S2) use of IDFracture (a fracture risk prediction tool specifically developed for adults with ID); and (S3) conducting a one-time dual-energy X-ray absorptiometry (DXA) scan in all. S1 and S2 were followed by DXA scan for those at risk. At-risk individuals received treatment according to UK practice (bisphosphonates plus vitamin D and calcium for osteoporosis, and vitamin D and calcium alone for osteopenia). PRIMARY OUTCOME MEASURES: Direct healthcare costs and quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). RESULTS: In the base case, S2 (ICER: -£2568/QALY) was dominant (ie, less costly and more effective) and S3 (ICER: £1678/QALY) was cost-effective relative to S1 for major osteoporotic fracture (MOF). For hip fracture, S2 (ICER: £32 116/QALY) and S3 (ICER: £49 536/QALY) were not cost-effective relative to S1 under the National Institute for Health and Care Excellence-recommended cost-effectiveness thresholds. Findings from the sensitivity analyses were predominantly consistent with the base-case results. Subgroup analyses showed that age-specific and gender-specific strategies could be used. CONCLUSION: For people with ID aged ≥40 years, a proactive approach to risk assessment for MOF is not only clinically beneficial, but also cost-effective.

References

1. 1.Png, M. E., Frighi, V., Holt, T. A., Achana, F., Smith, M. C., Collins, G. S., Roast, J., & Petrou, S. (2026). Cost-effectiveness of osteoporotic fracture risk assessment in people with intellectual disabilities: a UK NHS modelling study. BMJ Open. https://doi.org/10.1136/bmjopen-2025-110008