Osteoporosis International

, Volume 22, Issue 6, pp 1799–1808

Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture


    • Department of MedicineUniversity of Alberta
    • 2F1.24 Walter Mackenzie Health Sciences CentreUniversity of Alberta Hospital
  • D. A. Lier
    • Institute of Health Economics
  • B. H. Rowe
    • Department of Emergency MedicineUniversity of Alberta
  • A. S. Russell
    • Department of MedicineUniversity of Alberta
  • F. A. McAlister
    • Department of MedicineUniversity of Alberta
  • W. P. Maksymowych
    • Department of MedicineUniversity of Alberta
  • D. A. Hanley
    • Department of MedicineUniversity of Calgary
  • D. W. Morrish
    • Department of MedicineUniversity of Alberta
  • J. A. Johnson
    • School of Public HealthUniversity of Alberta
Original Article

DOI: 10.1007/s00198-010-1412-1

Cite this article as:
Majumdar, S.R., Lier, D.A., Rowe, B.H. et al. Osteoporos Int (2011) 22: 1799. doi:10.1007/s00198-010-1412-1



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.


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.


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.


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.


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.


Economic analysisOsteoporosis treatmentQuality improvementRandomized trial

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010