UNLABELLED: In a randomized trial, a multifaceted intervention tripled rates of osteoporosis treatment in older patients with wrist fracture. An economic analysis of the trial now demonstrates that the intervention tested "dominates" usual care: over a lifetime horizon, it reduces fracture, increases quality-adjusted life years, and saves the healthcare system money. INTRODUCTION: In a randomized trial (N = 272), we reported a multifaceted quality improvement intervention directed at older patients and their physicians could triple rates of osteoporosis treatment within 6 months of a wrist fracture when compared with usual care (22% vs 7%). Alongside the trial, we conducted an economic evaluation. METHODS: Using 1-year outcome data from our trial and micro-costing time-motion studies, we constructed a Markov decision-analytic model to determine cost-effectiveness of the intervention compared with usual care over the patients' remaining lifetime. We took the perspective of third-party healthcare payers. In the base case, costs and benefits were discounted at 3% and expressed in 2006 Canadian dollars. One-way deterministic and probabilistic sensitivity analyses were conducted. RESULTS:Median age of patients was 60 years, 77% were women, and 72% had low bone mineral density (BMD). The intervention cost $12 per patient. Compared with usual care, the intervention strategy was dominant: for every 100 patients receiving the intervention, three fractures (one hip fracture) would be prevented, 1.1 quality-adjusted life year gained, and $26,800 saved by the healthcare system over their remaining lifetime. The intervention dominated usual care across numerous one-way sensitivity analyses: with respect to cost, the most influential parameter was drug price; in terms of effectiveness, the most influential parameter was rate of BMD testing. The intervention was cost saving in 80% of probabilistic model simulations. CONCLUSIONS: For outpatients with wrist fractures, our multifaceted osteoporosis intervention was cost-effective. Healthcare systems implementing similar interventions should expect to save money, reduce fractures, and gain quality-adjusted life expectancy.
RCT Entities:
UNLABELLED: In a randomized trial, a multifaceted intervention tripled rates of osteoporosis treatment in older patients with wrist fracture. An economic analysis of the trial now demonstrates that the intervention tested "dominates" usual care: over a lifetime horizon, it reduces fracture, increases quality-adjusted life years, and saves the healthcare system money. INTRODUCTION: In a randomized trial (N = 272), we reported a multifaceted quality improvement intervention directed at older patients and their physicians could triple rates of osteoporosis treatment within 6 months of a wrist fracture when compared with usual care (22% vs 7%). Alongside the trial, we conducted an economic evaluation. METHODS: Using 1-year outcome data from our trial and micro-costing time-motion studies, we constructed a Markov decision-analytic model to determine cost-effectiveness of the intervention compared with usual care over the patients' remaining lifetime. We took the perspective of third-party healthcare payers. In the base case, costs and benefits were discounted at 3% and expressed in 2006 Canadian dollars. One-way deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Median age of patients was 60 years, 77% were women, and 72% had low bone mineral density (BMD). The intervention cost $12 per patient. Compared with usual care, the intervention strategy was dominant: for every 100 patients receiving the intervention, three fractures (one hip fracture) would be prevented, 1.1 quality-adjusted life year gained, and $26,800 saved by the healthcare system over their remaining lifetime. The intervention dominated usual care across numerous one-way sensitivity analyses: with respect to cost, the most influential parameter was drug price; in terms of effectiveness, the most influential parameter was rate of BMD testing. The intervention was cost saving in 80% of probabilistic model simulations. CONCLUSIONS: For outpatients with wrist fractures, our multifaceted osteoporosis intervention was cost-effective. Healthcare systems implementing similar interventions should expect to save money, reduce fractures, and gain quality-adjusted life expectancy.
Authors: Russel Burge; Bess Dawson-Hughes; Daniel H Solomon; John B Wong; Alison King; Anna Tosteson Journal: J Bone Miner Res Date: 2007-03 Impact factor: 6.741
Authors: Daniel H Solomon; Jerry Avorn; Jeffrey N Katz; Joel S Finkelstein; Marilyn Arnold; Jennifer M Polinski; M Alan Brookhart Journal: Arch Intern Med Date: 2005-11-14
Authors: Sumit R Majumdar; Jeffrey A Johnson; Finlay A McAlister; Debbie Bellerose; Anthony S Russell; David A Hanley; Don W Morrish; Walter P Maksymowych; Brian H Rowe Journal: CMAJ Date: 2008-02-26 Impact factor: 8.262
Authors: Sumit R Majumdar; Brian H Rowe; Deb Folk; Jeffrey A Johnson; Brian H Holroyd; Donald W Morrish; Walter P Maksymowych; Ivan P Steiner; Charles H Harley; Brian J Wirzba; David A Hanley; Sandra Blitz; Anthony S Russell Journal: Ann Intern Med Date: 2004-09-07 Impact factor: 25.391
Authors: L Bessette; L-G Ste-Marie; S Jean; K S Davison; M Beaulieu; M Baranci; J Bessant; J P Brown Journal: Osteoporos Int Date: 2007-07-20 Impact factor: 4.507
Authors: Catherine MacLean; Sydne Newberry; Margaret Maglione; Maureen McMahon; Veena Ranganath; Marika Suttorp; Walter Mojica; Martha Timmer; Alicia Alexander; Melissa McNamara; Sheetal B Desai; Annie Zhou; Susan Chen; Jason Carter; Carlo Tringale; Di Valentine; Breanne Johnsen; Jennifer Grossman Journal: Ann Intern Med Date: 2007-12-17 Impact factor: 25.391
Authors: D Marsh; K Akesson; D E Beaton; E R Bogoch; S Boonen; M-L Brandi; A R McLellan; P J Mitchell; J E M Sale; D A Wahl Journal: Osteoporos Int Date: 2011-05-24 Impact factor: 4.507