BACKGROUND: Most older patients are not treated for osteoporosis after fragility fracture. In a 3-armed randomized trial, we reported that 2 inexpensive mail-based interventions, one directed at physicians and the other at physicians plus patients, increased 1-year osteoporosis treatment starts by 4% and 6% (respectively) compared with usual care starts of 11%. The cost-effectiveness of these interventions is unknown. METHODS: The incremental cost-effectiveness of interventions compared with usual care was assessed using Markov decision-analytic models. Costs were expressed in 2010 Canadian dollars and long-term effectiveness based on quality-adjusted life years (QALYs) gained derived from hypothetical model simulations. The perspective was third-party health care payer; the time horizon was lifetime; and the costs and benefits were discounted 3%. RESULTS: The physician intervention cost was $7.12 per patient, whereas the physician plus patient intervention cost was $8.45. Compared with usual care, the economic simulation demonstrated that for every 1000 patients getting the physician intervention, there were 2 fewer fractures, 2 more QALYs gained, and $22,000 saved. Compared with physician intervention, the simulation demonstrated that for every 1000 patients receiving physician plus patient intervention, there was 1 fewer fracture and 1 more QALY gained, with $18,000 saved. Both interventions dominated usual care and were cost saving or highly cost effective in 67% of 10 000 probabilistic simulations. Although the physician plus patient intervention cost was $1.33 more per patient than the physician intervention, it was still the most economically attractive option. CONCLUSIONS: Pragmatic mail-based interventions directed at patients with recent fractures and their physicians are a highly cost-effective means to improving osteoporosis management and both interventions dominated usual care.
RCT Entities:
BACKGROUND: Most older patients are not treated for osteoporosis after fragility fracture. In a 3-armed randomized trial, we reported that 2 inexpensive mail-based interventions, one directed at physicians and the other at physicians plus patients, increased 1-year osteoporosis treatment starts by 4% and 6% (respectively) compared with usual care starts of 11%. The cost-effectiveness of these interventions is unknown. METHODS: The incremental cost-effectiveness of interventions compared with usual care was assessed using Markov decision-analytic models. Costs were expressed in 2010 Canadian dollars and long-term effectiveness based on quality-adjusted life years (QALYs) gained derived from hypothetical model simulations. The perspective was third-party health care payer; the time horizon was lifetime; and the costs and benefits were discounted 3%. RESULTS: The physician intervention cost was $7.12 per patient, whereas the physician plus patient intervention cost was $8.45. Compared with usual care, the economic simulation demonstrated that for every 1000 patients getting the physician intervention, there were 2 fewer fractures, 2 more QALYs gained, and $22,000 saved. Compared with physician intervention, the simulation demonstrated that for every 1000 patients receiving physician plus patient intervention, there was 1 fewer fracture and 1 more QALY gained, with $18,000 saved. Both interventions dominated usual care and were cost saving or highly cost effective in 67% of 10 000 probabilistic simulations. Although the physician plus patient intervention cost was $1.33 more per patient than the physician intervention, it was still the most economically attractive option. CONCLUSIONS: Pragmatic mail-based interventions directed at patients with recent fractures and their physicians are a highly cost-effective means to improving osteoporosis management and both interventions dominated usual care.
Authors: D E Beaton; M Vidmar; K B Pitzul; R Sujic; N K Rotondi; E R Bogoch; J E M Sale; R Jain; J Weldon Journal: Osteoporos Int Date: 2016-10-21 Impact factor: 4.507
Authors: Raj S Padwal; Scott Klarenbach; Arya M Sharma; Miriam Fradette; Susan E Jelinski; Alun Edwards; Sumit R Majumdar Journal: BMC Med Date: 2017-03-02 Impact factor: 8.775
Authors: Lei Si; John A Eisman; Tania Winzenberg; Kerrie M Sanders; Jacqueline R Center; Tuan V Nguyen; Andrew J Palmer Journal: BMJ Open Date: 2019-02-18 Impact factor: 2.692
Authors: Margaret K Pasquale; Richard L Sheer; Alon Yehoshua; Adrienne McFadden; Arkadi Chines; John Caloyeras Journal: Med Care Date: 2021-02-01 Impact factor: 3.178