Cost-effectiveness of the Concord Minimal Trauma Fracture Liaison service, a prospective, controlled fracture prevention study
- 814 Downloads
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.
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.
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.
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.
The MTFL service is a cost-effective intervention to reduce recurrent osteoporotic fractures.
KeywordsCost-effectiveness Costs Fracture Fracture liaison service Health economics Osteoporosis Re-fracture
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
- 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, FootscrayGoogle 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
- 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
- 22.Australian Government Department of Health and Ageing (2010) Medicare benefits schedule book. Nov 2009–2010Google 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, VictoriaGoogle 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 628422Google Scholar
- 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 2011Google 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):1344–1352PubMedCrossRefGoogle 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 2011Google 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):83–91PubMedCrossRefGoogle 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):1809–1822PubMedCrossRefGoogle 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):1799–1809PubMedCrossRefGoogle 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):2083–2098PubMedCrossRefGoogle Scholar
- 40.The Royal Australian College of General Practitioners (2010) Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older menGoogle Scholar
- 41.Department of Health (2009) Fracture Prevention Services: an economic evaluation. www.dh.gov.uk/publications. Accessed 1 Jul 2011
- 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 2011Google Scholar