HTA Study on REMS

​SDA Bocconi University: REMS helps cut NHS costs

According to the HTA independent research conducted by the lecturers Patrizio Armeni and Ludovica Borsoi of the Centre for research on health and social care management (Cergas) of SDA Bocconi, the new technology patented by Echolight and already included in the Guidelines for Fragility Fractures as best practice is more efficient than bone densitometry.

Developed by the Italian biomedical company Echolight – spin-off of the Italian National Research Council of Lecce -, compared to the use of the conventional Dual-energy X-Ray (DXA) bone densitometer the new Radiofrequency Ecographic Multi Spectrometry (REMS) technology offers greater saving for the National Healthcare System when it comes to diagnosing Osteoporosis and bone fragility.

This important accolade of REMS regarding a better “economic sustainability”, certified by an independent study carried out by Italy’s most prestigious business school, comes along an equally important clinical objective achieved on 18 October 2021 when REMS earned a spot in Guidelines for Fragility Fractures issued by the Italian National Institute of Health.

The HTA work group

According to the definition of the Agenas (the Italian National Agency for Regional Healthcare Services), HTA multidisciplinary research allows to accurately assess new medical technologies from various points of view:

• effectiveness,
• safety,
• costs (direct and indirect),
• socio-organisational impact.

Led by Prof. Patrizio Armeni, CERGAS SDA Bocconi is Italy’s most qualified work group as regards this type of research. Associate professor of Practice of Government, Health and Not for Profit at the SDA Bocconi School of Management, Armeni coordinates the “Economic and Health Technology Assessments” research department of the Centre for research on health and social care management.

In the research on REMS, Prof. Armeni was assisted by Dr. Ludovica Borsoi, Junior Lecturer within the Government, Health & Not for Profit (GHNP) Knowledge Group at the Bocconi School of Business Management and researcher in the CERGAS Economic and Health Technology Assessments Department.

Presentation webinar

The HTA is therefore the result of an analysis of the actual and potential impact of a technological innovation in the healthcare industry on the healthcare system, the economy, and the society as a whole.

The results of the research on REMS were presented on 18 May 2022 at a webinar entitled “Valutazione economica a supporto dell’HTA della tecnologia REMS nella diagnosi dell’osteoporosi: risultati e raccomandazioni (Economic Assessment to support the HTA of REMS Technology in diagnosing osteoporosis: findings and recommendations)” which, besides the two Bocconi academicians, was graced by the attendance of the President of the Observatory for Fragility Fractures (OFF), Maria Luisa Brandi. After focusing on the great clinical potential of technology, stemming from the inclusion in the October 2021 Ministerial Guidelines, following the work carried out by eight scientific societies together with patient associations, Prof. Maria Luisa Brandi called the new REMS technology “revolutionary, being the first worldwide.”

“The examination of the lumbar vertebrae takes 80 seconds while that of a proximal femur requires 40 seconds: two minutes in total”, Prof. Brandi pointed out highlighting the fact that REMS had been recently approved for the clinical use by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and that the validation of clinical studies covered more than 15 thousand people, with more than 300 studies published. 

The purpose of Health Technology Assessment  

“We conducted a multidisciplinary research capable of covering the various aspects, from clinical to social-economic, in support of an efficient, explicit and transparent allocation of resources,” Dr. Ludovica Borsoi expounded.

“The cost analysis covered both the costs of each diagnosis and the one-off costs of purchasing the device and training the healthcare staff.”

“Considering that in recent years there has been a huge debate on the sustainability of the healthcare system, given the availability of resources, raising questions on how and where to allocate them, we need governance tools”.

And special focus is placed on Osteoporosis, which is considered one of the most significant diseases in decision-making processes, as it is an expanding disease, given that it linked to the ongoing demographic changes: “According to data from the International Osteoporosis Foundation for 2019, 4.4 million people suffer from osteoporosis,” the researcher pointed out.

The comparative assessment of REMS-DXA

Who ranked at the top of the Health Technology Assessment? The research revealed several strengths of REMS compared to DXA:

• the absence of radiations which ensures non-invasive diagnosis
• the small size of the instrument which is portable and easy-to-handle
• the ultra-high predictive accuracy of the equipment

Approved by the Ethics Committee of Bocconi University, the HTA was used to assess the economic impact of the REMS approach compared to the conventional use of DXA, considered the gold standard for the osteoporosis diagnosis until recently.

“The DXA for the osteoporosis diagnosis has several factors that hinder its suitability for screening and mass diagnosis: the cost of technology, the use of radiation and therefore a limited accessibility,” Borsoi emphasised.

“On the other hand, REMS is non-ionizing and has a diagnostic precision and accuracy similar to DXA,” she said. “As regards the vertebral site, compared to DXA there was observed a greater ability to identify true positives and similar ability to identify true negatives,” she added. “It is a diagnostic technology that can facilitate the patient’s care experience, according to the Italian inter-society ministerial guidelines published in 2021”, she pointed out.

Economic assessment: REMS scoops top award!

As regards the economic assessment for the direct cost minimisation analysis for the National Healthcare System, the research was based on the assumption that REMS and DXA have at least similar diagnostic precision and accuracy and therefore guarantee equivalent health outcomes.

The reference sample of the population was large: women aged between 30 and 90 years and using quality-based interviews were asked to identify the types of healthcare resources they gained access to for in osteoporosis diagnosis.

“The results of the cost minimisation analysis conducted from the point of view of the Italian National Healthcare System indicate that the REMS approach is associated with lower direct healthcare costs compared to DXA,” said Prof. Armeni.

REMS therefore overcomes the shortcomings of DXA:

• it has a lower purchase cost,
• it has lower average current costs,
• it has lower staff training costs.

And these savings relate only to public spending… expanding the field to a broader perspective and looking at the impact across the Italian society, the savings associated with using REMS are even greater if we consider transportation costs regarding patients and their relatives, caregiving and loss of productivity.