Journal
OSTEOPOROSIS INTERNATIONAL
Volume 28, Issue 6, Pages 1965-1977Publisher
SPRINGER LONDON LTD
DOI: 10.1007/s00198-017-3986-3
Keywords
Cost-effectiveness analysis; Fracture liaison services; Fragility fracture; Guidelines; Osteoporosis treatment; Quality improvement
Categories
Funding
- Alberta Innovates (STOP-PRIHS grant)
- Faculty of Medicine and Dentistry at the University of Alberta
- Faculty of Pharmacy and Pharmaceutical Sciences at the University of Alberta
- Canadian Institutes of Health Research
- Alberta Innovates
- Alberta Innovates [201400391] Funding Source: researchfish
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Fracture liaison services (FLS) are advocated to improve osteoporosis treatment after fragility fracture, but there are few economic analyses of different models. A population-based 1i [=type C] FLS for non-hip fractures was implemented and it costs $44 per patient and it was very cost-effective ($9200 per QALY gained). Small operational changes would convert it from cost-effective to cost-saving. After fragility fracture, < 20% of patients receive osteoporosis treatment. FLS are recommended to address this deficit but there are very few economic analyses of different FLS models. Therefore, we conducted an economic analysis of a 1i (=type C) FLS called Catch a Break (CaB). CaB is a population-based FLS in Alberta, Canada, that case-finds older outpatients with non-traumatic upper extremity, spine, pelvis, or other non-hip fractures and provides telephonic outreach and printed educational materials to patients and their physicians. Cost-effectiveness was assessed using Markov decision-analytic models. Costs were expressed in 2014 Canadian dollars and effectiveness based on model simulations of recurrent fractures and quality-adjusted life years (QALYs). Perspective was healthcare payer; horizon was lifetime; and costs and benefits were discounted 3%. Over 1 year, CaB enrolled 7323 outpatients (mean age 67 years, 75% female, 69% upper extremity) at average cost of $44 per patient. Compared with usual care, CaB increased rates of bisphosphonate treatment by 4.3 to 17.5% (p < 0.001). Over their lifetime, for every 10,000 patients enrolled in CaB, 4 hip fractures (14 fractures total) would be avoided and 12 QALYs gained. Compared with usual care, incremental cost-effectiveness of CaB was estimated at $9200 per QALY. CaB was cost-effective in 85% of 10,000 probabilistic simulations. Sensitivity analyses showed if other fractures were excluded and intervention costs reduced 25% that CaB would become cost-saving. A relatively inexpensive population-based 1i (=type C) FLS was implemented in Alberta and it was very cost-effective. If CaB excluded other fractures and decreased intervention costs by 25%, it would be cost-saving, as would any FLS that was more effective and less expensive.
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