Cost-effectiveness of a fracture liaison service—a real-world evaluation after 6 years of service provision

J. H.E. Yong, L. Masucci, Jeffrey S Hoch, R. Sujic, D. Beaton

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Summary: The cost-effectiveness of a less intensive fracture liaison service is unknown. We evaluated a fracture liaison service that had been educating and referring patients for secondary prevention of osteoporotic fractures for 6 years. Our results suggest that a less intensive fracture liaison service, with moderate effectiveness, can still be worthwhile. Introduction: Fragility fractures are common among older patients; the risk of re-fracture is high but could be reduced with treatments; different versions of fracture liaison service have emerged to reduce recurrent osteoporotic fractures. But the cost-effectiveness of a less intensive model is unknown. The objective of this study was to assess the cost-effectiveness of the Ontario Fracture Clinic Screening program, a fracture liaison service that had been educating and referring fragility fracture patients across Ontario, Canada to receive bone mineral density testing and osteoporosis treatments since 2007. Methods: We developed a Markov model to assess the cost-effectiveness of the program over the patients’ remaining lifetime, using rates of bone mineral density testing and osteoporosis treatment and cost of intervention from the program, and supplemented it with the published literature. The analysis took the perspective of a third-party health-care payer. Costs and benefits were discounted at 5 % per year. Sensitivity analyses assessed the effects of different assumptions on the results. Results: The program improved quality-adjusted life-years (QALYs) by 4.3 years and led to increased costs of CAD $83,000 for every 1000 patients screened, at a cost of $19,132 per QALY gained. The enhanced model, the Bone Mineral Density (BMD) Fast Track program that includes ordering bone mineral density testing, was even more cost-effective ($5720 per QALY gained). Conclusions: The Ontario Fracture Clinic Screening program appears to be a cost-effective way to reduce recurrent osteoporotic fractures.

Original languageEnglish (US)
Pages (from-to)231-240
Number of pages10
JournalOsteoporosis International
Volume27
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Fingerprint

Cost-Benefit Analysis
Bone Density
Osteoporotic Fractures
Quality-Adjusted Life Years
Ontario
Costs and Cost Analysis
Osteoporosis
Secondary Prevention
Health Care Costs
Canada
Delivery of Health Care
Therapeutics

Keywords

  • Cost-effectiveness
  • Economics
  • Fracture
  • Fracture liaison service
  • Osteoporosis
  • Secondary prevention

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Cost-effectiveness of a fracture liaison service—a real-world evaluation after 6 years of service provision. / Yong, J. H.E.; Masucci, L.; Hoch, Jeffrey S; Sujic, R.; Beaton, D.

In: Osteoporosis International, Vol. 27, No. 1, 01.01.2016, p. 231-240.

Research output: Contribution to journalArticle

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abstract = "Summary: The cost-effectiveness of a less intensive fracture liaison service is unknown. We evaluated a fracture liaison service that had been educating and referring patients for secondary prevention of osteoporotic fractures for 6 years. Our results suggest that a less intensive fracture liaison service, with moderate effectiveness, can still be worthwhile. Introduction: Fragility fractures are common among older patients; the risk of re-fracture is high but could be reduced with treatments; different versions of fracture liaison service have emerged to reduce recurrent osteoporotic fractures. But the cost-effectiveness of a less intensive model is unknown. The objective of this study was to assess the cost-effectiveness of the Ontario Fracture Clinic Screening program, a fracture liaison service that had been educating and referring fragility fracture patients across Ontario, Canada to receive bone mineral density testing and osteoporosis treatments since 2007. Methods: We developed a Markov model to assess the cost-effectiveness of the program over the patients’ remaining lifetime, using rates of bone mineral density testing and osteoporosis treatment and cost of intervention from the program, and supplemented it with the published literature. The analysis took the perspective of a third-party health-care payer. Costs and benefits were discounted at 5 {\%} per year. Sensitivity analyses assessed the effects of different assumptions on the results. Results: The program improved quality-adjusted life-years (QALYs) by 4.3 years and led to increased costs of CAD $83,000 for every 1000 patients screened, at a cost of $19,132 per QALY gained. The enhanced model, the Bone Mineral Density (BMD) Fast Track program that includes ordering bone mineral density testing, was even more cost-effective ($5720 per QALY gained). Conclusions: The Ontario Fracture Clinic Screening program appears to be a cost-effective way to reduce recurrent osteoporotic fractures.",
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