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

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Abstract

Summary

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.

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Acknowledgments

Sumit R. Majumdar, Jeffrey A. Johnson, Finlay A. McAlister, and Walter P. Maksymowych receive salary support awards from the Alberta Heritage Foundation for Medical Research (AHFMR); Jeffrey A. Johnson (JAJ) and Brian H. Rowe (BHR) hold Canada Research Chairs. The study was supported by peer-reviewed grants from AHFMR and the Canadian Institutes of Health Research (MOP #79325).

Conflicts of interest

None of the authors has any actual or potential conflicts of interest to declare except DA Hanley: He has been an investigator in sponsored clinical trials of alendronate and risedronate. He has received honoraria, for speaking and membership on advisory boards, from Merck Frosst Canada and Procter and Gamble.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Alberta, Edmonton, AB, Canada

    S. R. Majumdar, A. S. Russell, F. A. McAlister, W. P. Maksymowych & D. W. Morrish

  2. Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada

    B. H. Rowe

  3. School of Public Health, University of Alberta, Edmonton, AB, Canada

    J. A. Johnson

  4. Institute of Health Economics, Edmonton, AB, Canada

    D. A. Lier

  5. Department of Medicine, University of Calgary, Calgary, AB, Canada

    D. A. Hanley

  6. 2F1.24 Walter Mackenzie Health Sciences Centre, University of Alberta Hospital, 8440-112th Street, Edmonton, AB, Canada, T6G 2B7

    S. R. Majumdar

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  1. S. R. Majumdar
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  2. D. A. Lier
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  7. D. A. Hanley
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Correspondence to S. R. Majumdar.

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Trial Registry

clinicaltrials.gov identifier: NCT00152321

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Majumdar, S.R., Lier, D.A., Rowe, B.H. et al. Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture. Osteoporos Int 22, 1799–1808 (2011). https://doi.org/10.1007/s00198-010-1412-1

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  • DOI: https://doi.org/10.1007/s00198-010-1412-1

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