Quantifying the Opportunity and Economic Value of Bone Density Screening Using Opportunistic CT: A Medicare Database Analysis

Abstract

Purpose: The aim of this study was to determine the potential impact of opportunistic CT bone density screening in terms of increasing screening rates and cost avoidance. Methods: The analytic dataset was extracted from the Medicare 5% Research Identifiable Files (2015-2022). All dual-energy x-ray absorptiometry (DEXA) procedures and contrast and/or noncontrast CT procedures of pertinent body regions were identified using Current Procedural Terminology codes. Outcomes of interest included osteoporosis screening imaging and fragility fractures of the hip or spine. Potential annual cost avoidance was calculated. Results: In total, 2,897,040 beneficiaries were identified for analysis, of whom 584,391 beneficiaries (20.2%) underwent DEXA and 658,703 beneficiaries (22.7%) did not undergo DEXA but did undergo at least one CT examination that included the L1 vertebral body, 446,706 (67.8%) without and 211,997 (32.2%) with contrast. In the noncontrast and contrast CT groups, there were 2,766 (0.6%) and 613 (0.3%) hip and 23,889 (5.3%) and 5,222 (2.5%) spine fragility fractures within 1 year of CT. The osteoporosis screening rate would increase by 76% using only noncontrast CT studies and by 113% using all CT studies. If only noncontrast CT was used to identify osteoporosis and treatment was successfully implemented in 100% of eligible beneficiaries, this study population would see a medical cost avoidance in excess of $17 million. If any CT was used, potential annual cost avoidance for this study's population would be nearly $100 million and $2.5 billion for all 2023 Medicare fee-for-service beneficiaries. Conclusions: Implementing opportunistic CT bone density screening could potentially have a substantial patient care and economic impact.