Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture
- First Online:
- 369 Downloads
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.
KeywordsEconomic analysis Osteoporosis treatment Quality improvement Randomized trial
- 2.National Osteoporosis Foundation (2008) Clinicians’ guide to prevention and treatment of osteoporosis. Available at: http://www.nof.org/professionals/NOF_Clinicians_Guide.pdf/. Accessed 14 August 2010)
- 3.Scientific Advisory Council, Osteoporosis Society of Canada (2002) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167(suppl):S1–S34Google Scholar
- 13.Strom O, Zethraeus N, Borgstršm F, Johnell O, Jšnsson B, Kanis J. IOF cost-effectiveness reference model: background document. International Osteoporosis Foundation. Available at: http://www.iofbonehealth.org. Accessed 5 March 2010
- 21.Majumdar SR, Johnson JA, Bellerose D, McAlister FA, Russell AS, Hanley DA, et al (2010) Nurse case-manager vs multifaceted intervention to improve quality of osteoporosis care after wrist fracture: randomized controlled pilot study. Osteoporos Int doi:10.1007/s00198-010-1212-7
- 22.Alberta Health Care Insurance Plan (2006) Schedule of medical benefits (procedures and price list). Alberta Health Care, Edmonton, Alberta, CanadaGoogle Scholar
- 23.Alberta Health and Wellness (2007) Drug benefits list. Alberta Health and Wellness, Edmonton, Alberta, CanadaGoogle Scholar
- 24.Alberta Health and Wellness (2006) Health Costing in Alberta - Annual Report. Edmonton, Alberta, CanadaGoogle Scholar
- 25.Canadian Institute for Health Information (2006) Resource intensity weights and expected length of stay. Canadian Institute for Health Information, Ottawa, Ontario, CanadaGoogle Scholar
- 27.Statistics Canada (2006) Life tables—Canada, provinces and territories, 2000–2002 (84–537-XIE). Statistics Canada, Ottawa, Ontario, CanadaGoogle Scholar
- 30.Statistics Canada (2009) Labour force survey estimates (LFS)—wages of employees by type of work, National Occupational Classification for Statistics (NOC-S), sex and age group, unadjusted for seasonality, computed annual average (Table 282-0069). Statistics Canada, Ottawa, Ontario, CanadaGoogle Scholar