UNLABELLED: We evaluated the cost-effectiveness of a fracture liaison service prospectively designed to have a parallel control group treated by standard care. The clinical effectiveness of this service was associated with an incremental cost-effectiveness ratio versus standard care of Australian dollars (AUD) 17,291 per quality-adjusted life year (QALY) gained. INTRODUCTION: Osteoporotic fractures are a major burden for national health services. The risk of re-fracture following an osteoporotic fracture is particularly high. In a study unique in prospectively having a control group treated by standard care, we recently demonstrated that a Minimal Trauma Fracture Liaison (MTFL) service significantly reduces the risk of re-fracture by 80%. Since the service involves greater use of resources, we have now evaluated whether it is cost-effective. METHODS: A Markov model was developed that incorporated fracture probabilities and resource utilization data (expressed in AUD) obtained directly from the 4-year MTFL service clinical study. Resource utilization, local cost and mortality data and fracture-related health utility data were used to calculate QALYs with the MTFL service and standard care. Main outcome measures were: additional costs of the MTFL service over standard care, the financial savings achieved through reduced fractures and changes in QALYs associated with reduced fractures calculated over a 10-year simulation period. Costs and QALYs were discounted at 5% annually. Sensitivity analyses quantified the effects of different assumptions of effectiveness and resource utilization associated with the MTFL service. RESULTS: The MTFL service improved QALYs by 0.089 years and led to increased costs of AUD 1,486 per patient versus standard care over the 10-year simulation period. The incremental cost-effectiveness ratio versus standard care was AUD 17,291 per QALY gained. Results were robust under all plausible assumptions. CONCLUSIONS: The MTFL service is a cost-effective intervention to reduce recurrent osteoporotic fractures.
UNLABELLED: We evaluated the cost-effectiveness of a fracture liaison service prospectively designed to have a parallel control group treated by standard care. The clinical effectiveness of this service was associated with an incremental cost-effectiveness ratio versus standard care of Australian dollars (AUD) 17,291 per quality-adjusted life year (QALY) gained. INTRODUCTION:Osteoporotic fractures are a major burden for national health services. The risk of re-fracture following an osteoporotic fracture is particularly high. In a study unique in prospectively having a control group treated by standard care, we recently demonstrated that a Minimal Trauma Fracture Liaison (MTFL) service significantly reduces the risk of re-fracture by 80%. Since the service involves greater use of resources, we have now evaluated whether it is cost-effective. METHODS: A Markov model was developed that incorporated fracture probabilities and resource utilization data (expressed in AUD) obtained directly from the 4-year MTFL service clinical study. Resource utilization, local cost and mortality data and fracture-related health utility data were used to calculate QALYs with the MTFL service and standard care. Main outcome measures were: additional costs of the MTFL service over standard care, the financial savings achieved through reduced fractures and changes in QALYs associated with reduced fractures calculated over a 10-year simulation period. Costs and QALYs were discounted at 5% annually. Sensitivity analyses quantified the effects of different assumptions of effectiveness and resource utilization associated with the MTFL service. RESULTS: The MTFL service improved QALYs by 0.089 years and led to increased costs of AUD 1,486 per patient versus standard care over the 10-year simulation period. The incremental cost-effectiveness ratio versus standard care was AUD 17,291 per QALY gained. Results were robust under all plausible assumptions. CONCLUSIONS: The MTFL service is a cost-effective intervention to reduce recurrent osteoporotic fractures.
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
Authors: S T Harris; N B Watts; H K Genant; C D McKeever; T Hangartner; M Keller; C H Chesnut; J Brown; E F Eriksen; M S Hoseyni; D W Axelrod; P D Miller Journal: JAMA Date: 1999-10-13 Impact factor: 56.272
Authors: R Lindsay; S L Silverman; C Cooper; D A Hanley; I Barton; S B Broy; A Licata; L Benhamou; P Geusens; K Flowers; H Stracke; E Seeman Journal: JAMA Date: 2001-01-17 Impact factor: 56.272
Authors: Dennis M Black; Pierre D Delmas; Richard Eastell; Ian R Reid; Steven Boonen; Jane A Cauley; Felicia Cosman; Péter Lakatos; Ping Chung Leung; Zulema Man; Carlos Mautalen; Peter Mesenbrink; Huilin Hu; John Caminis; Karen Tong; Theresa Rosario-Jansen; Joel Krasnow; Trisha F Hue; Deborah Sellmeyer; Erik Fink Eriksen; Steven R Cummings Journal: N Engl J Med Date: 2007-05-03 Impact factor: 91.245
Authors: Cynthia L Leibson; Anna N A Tosteson; Sherine E Gabriel; Jeanine E Ransom; L Joseph Melton Journal: J Am Geriatr Soc Date: 2002-10 Impact factor: 5.562
Authors: T P Olenginski; G Maloney-Saxon; C K Matzko; K Mackiewicz; H L Kirchner; A Bengier; E D Newman Journal: Osteoporos Int Date: 2014-11-15 Impact factor: 4.507
Authors: Ryan P Farmer; Benoit Herbert; Derly O Cuellar; Jiandong Hao; Philip F Stahel; Robin Yasui; David J Hak; Cyril Mauffrey Journal: Int Orthop Date: 2014-03-21 Impact factor: 3.075
Authors: Jose Leal; Alastair M Gray; Samuel Hawley; Daniel Prieto-Alhambra; Antonella Delmestri; Nigel K Arden; Cyrus Cooper; M Kassim Javaid; Andrew Judge Journal: J Bone Miner Res Date: 2016-11-01 Impact factor: 6.741