Skip to main content

Advertisement

Log in

Cost-effectiveness of the Concord Minimal Trauma Fracture Liaison service, a prospective, controlled fracture prevention study

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Anonymous (2007) The burden of brittle bones. Epidemiology, costs and burden of osteoporosis in Australia-2007. Department of Medicine, University of Melbourne, Western Hospital, Footscray

    Google Scholar 

  2. Anonymous (2001) Access economics. The burden of brittle bones: costing osteoporosis in Australia. http://www.arthritiswa.org.au/Resources/Osteoporosis%20Reports/Brittle%20Bones.pdf. Accessed 1 Jul 2011

  3. Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ 3rd (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137(9):1001–1005

    PubMed  CAS  Google Scholar 

  4. Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50(10):1644–1650

    Article  PubMed  Google Scholar 

  5. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767

    Article  PubMed  Google Scholar 

  6. Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1990) Predictors of functional recovery 1 year following hospital discharge for hip fracture: a prospective study. J Gerontol 45(3):M101–M107

    PubMed  CAS  Google Scholar 

  7. Miller CW (1978) Survival and ambulation following hip fracture. J Bone Joint Surg Am 60(7):930–934

    PubMed  CAS  Google Scholar 

  8. Johnell O, Oden A, Caulin F, Kanis JA (2001) Acute and long-term increase in fracture risk after hospitalization for vertebral fracture. Osteoporos Int 12(3):207–214

    Article  PubMed  CAS  Google Scholar 

  9. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285(3):320–323

    Article  PubMed  CAS  Google Scholar 

  10. Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114(11):919–923

    PubMed  CAS  Google Scholar 

  11. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828

    Article  PubMed  CAS  Google Scholar 

  12. Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297(4):387–394

    Article  PubMed  CAS  Google Scholar 

  13. Sale JE, Beaton D, Posen J, Elliot-Gibson V, Bogoch E (2011) Systematic review on interventions to improve osteoporosis investigation and treatment in fragility fracture patients. Osteoporos Int 22(7):2067–2082

    Article  PubMed  CAS  Google Scholar 

  14. Bliuc D, Ong CR, Eisman JA, Center JR (2005) Barriers to effective management of osteoporosis in moderate and minimal trauma fractures: a prospective study. Osteoporos Int 16(8):977–982

    Article  PubMed  Google Scholar 

  15. Panneman MJ, Lips P, Sen SS, Herings RM (2004) Undertreatment with anti-osteoporotic drugs after hospitalization for fracture. Osteoporos Int 15(2):120–124

    Article  PubMed  Google Scholar 

  16. Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35(5):293–305

    Article  PubMed  CAS  Google Scholar 

  17. Lih A, Nandapalan H, Kim M, Yap C, Lee P, Ganda K, Seibel MJ (2011) Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study. Osteoporos Int 22(3):849–858

    Article  PubMed  CAS  Google Scholar 

  18. Briggs A, Sculpher M (1998) An introduction to Markov modelling for economic evaluation. Pharmacoeconomics 13(4):397–409

    Article  PubMed  CAS  Google Scholar 

  19. Commonwealth Department of Human Services and Health (2005) Guidelines for the pharmaceutical industry on preparation of submissions to the Pharmaceutical Benefits Advisory Committee. http://www.health.gov.au/pbs/pharm/pubs/guidelines/index.htm. Accessed 1 Jul 2011

  20. WHO (2007)World Health Organization. Life tables for 191 countries. World mortality in 2005. http://www3.who.int/whosis/life_tables/life_tables.cfm. Accessed 1 Jul 2011

  21. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301(5):513–521

    Article  PubMed  CAS  Google Scholar 

  22. Australian Government Department of Health and Ageing (2010) Medicare benefits schedule book. Nov 2009–2010

  23. Cramer JA, Gold DT, Silverman SL, Lewiecki EM (2007) A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 18(8):1023–1031

    Article  PubMed  CAS  Google Scholar 

  24. Harris A, Watts J, Ebeling P, Crowely S (1998) The burden of illness and the cost of osteoporosis in Australia. Centre for Health Program Evaluation, Monash University, Victoria

    Google Scholar 

  25. Reserve Bank of Australia inflation calculator website http://www.rba.gov.au/calculator/annualDecimal.html. Accessed 1 Jul 2011

  26. The Australian Study of Cost and Utilities Related to Osteoporotic Fractures NHMRC application ID 628422

  27. Kind P, Dolan P, Gudex C, Williams A (1998) Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ 316(7133):736–741. Accessed 1 Jul 2011

    Google Scholar 

  28. Hiligsmann M, Ethgen O, Richy F, Reginster JY (2008) Utility values associated with osteoporotic fracture: a systematic review of the literature. Calcif Tissue Int 82:288–292

    Article  PubMed  CAS  Google Scholar 

  29. Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15:175–179

    Article  PubMed  CAS  Google Scholar 

  30. XE currency converter. http://www.xe.com/ict/?utm_source=internal&utm_medium=TL&utm_content=NOGEO&utm_campaign=ICT_HistRates_QuickLinksHome. Accessed 1 Jul 2011

  31. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH 3rd, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282(14):1344–1352

    Article  PubMed  CAS  Google Scholar 

  32. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348(9041):1535–1541. Accessed 1 Jul 2011

    Google Scholar 

  33. Reginster J, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, Lund B, Ethgen D, Pack S, Roumagnac I, Eastell R (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int 11(1):83–91

    Article  PubMed  CAS  Google Scholar 

  34. Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356(18):1809–1822

    Article  PubMed  CAS  Google Scholar 

  35. Lyles KW, Colon-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L, Moore KA, Lavecchia C, Zhang J, Mesenbrink P, Hodgson PK, Abrams K, Orloff JJ, Horowitz Z, Eriksen EF, Boonen S (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357(18):1799–1809

    Article  PubMed  CAS  Google Scholar 

  36. Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ (1992) Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 327(23):1637–1642

    Article  PubMed  CAS  Google Scholar 

  37. Marsh D, Akesson K, Beaton DE, Bogoch ER, Boonen S, Brandi ML, McLellan AR, Mitchell PJ, Sale JE, Wahl DA (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22(7):2051–2065

    Article  PubMed  CAS  Google Scholar 

  38. Cooper C, Mitchell P, Kanis JA (2011) Breaking the fragility fracture cycle. Osteoporos Int 22(7):2049–2050

    Article  PubMed  CAS  Google Scholar 

  39. McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L, Adekunle F, Roberts D (2011) Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 22(7):2083–2098

    Article  PubMed  CAS  Google Scholar 

  40. The Royal Australian College of General Practitioners (2010) Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men

  41. Department of Health (2009) Fracture Prevention Services: an economic evaluation. www.dh.gov.uk/publications. Accessed 1 Jul 2011

  42. Randell A, Sambrook PN, Nguyen TV, Lapsley H, Jones G, Kelly PJ, Eisman JA (1995) Direct clinical and welfare costs of osteoporotic fractures in elderly men and women. Osteoporos Int 5(6):427–432

    Article  PubMed  CAS  Google Scholar 

  43. Borgstrom F, Strom O, Coelho J, Johansson H, Oden A, McCloskey EV, Kanis JA (2010) The cost-effectiveness of risedronate in the UK for the management of osteoporosis using the FRAX. Osteoporos Int 21(3):495–505. Accessed 1 Jul 2011

    Google Scholar 

  44. Hiligsmann M, Reginster JY (2010) Potential cost-effectiveness of denosumab for the treatment of postmenopausal osteoporotic women. Bone 47(1):34–40

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The MTFL service was supported by logistic support from Concord Repatriation General Hospital, by a Research Entry Grant from the Osteoporosis Australia/The Royal Australasian College of Physicians and by unrestricted research and educational grants from Sanofi-Aventis, Novartis Pharma and Merck Sharp & Dohme (MSD) Pharmaceuticals, Australia. The authors would like to acknowledge the contributions of Drs. Lih, Yap, Nandapalan, Lee, and Ganda in running the MTFL service at Concord Hospital, Sydney. MC was supported by a University of Sydney International Visiting Research Fellowship.

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. J. Seibel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cooper, M.S., Palmer, A.J. & Seibel, M.J. Cost-effectiveness of the Concord Minimal Trauma Fracture Liaison service, a prospective, controlled fracture prevention study. Osteoporos Int 23, 97–107 (2012). https://doi.org/10.1007/s00198-011-1802-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-011-1802-z

Keywords

Navigation