Health economics evaluation of screening for sarcopenia among community-dwelling older persons

Sarcopenia increased the risk of various adverse outcomes, including cardiovascular diseases, falls, and mortality. Implementing interventions could mitigate the harm caused by sarcopenia. With the dearth of health economics evaluation on sarcopenia screening, we aimed to evaluate the costs and benefits of sarcopenia screening strategies among community-dwelling older persons. We constructed a decision-analytic Markov model for a cohort of individuals aged 60 years and above with a total of 25 1-year cycles. A total of 20 screening strategies, with annual or biennial screening interval and 10 screening tools: SARC-F, MSRA-5, MSRA-7, calf circumference, Finger-ring test, Ishii test, SARC-CALF, AWGS 2019, SARC-F|MSRA-5 (Parallel test), and SARC-F|MSRA-7 (Parallel test), were assessed in our study. Cost-effectiveness analysis was conducted by calculating the cost, quality-adjusted life-years (QALYs) for each strategy. The corresponding incremental cost-effectiveness ratio (ICER) was obtained by comparing with no screening. Highly cost-effective strategies were considered if ICER was less than the per-capita GDP for China ($12,551.49), and the strategy with the lowest ICER was the most cost-effective. One-way deterministic and probabilistic sensitivity analyses (DSA & PSA) were used to assess the robustness of the main outcomes. Compared with no screening, all screening strategies were highly cost-effective. The most cost-effective screening strategy was biennial SARC-F|MSRA-7 screening ($1461.52/QALY), followed by annual SARC-F|MSRA-7 screening ($2147.82/QALY), biennial AWGS 2019 screening ($2340.21/QALY), and annual AWGS 2019 screening ($2419.16/QALY). DSA results indicated that the model was relatively stable. PSA results indicated that the probability of annual AWGS 2019 screening being cost-effective increased to 100%, when the willing-to-pay threshold increased to $9800. Combining the PSA results, we recommended conducting annual sarcopenia screening with AWGS 2019 among community-dwelling older adults in China.