Osteoporosis International

, Volume 22, Issue 6, pp 1799–1808 | Cite as

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

  • S. R. Majumdar
  • D. A. Lier
  • B. H. Rowe
  • A. S. Russell
  • F. A. McAlister
  • W. P. Maksymowych
  • D. A. Hanley
  • D. W. Morrish
  • J. A. Johnson
Original Article



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 analysis Osteoporosis treatment Quality improvement Randomized trial 


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • S. R. Majumdar
    • 1
    • 6
  • D. A. Lier
    • 4
  • B. H. Rowe
    • 2
  • A. S. Russell
    • 1
  • F. A. McAlister
    • 1
  • W. P. Maksymowych
    • 1
  • D. A. Hanley
    • 5
  • D. W. Morrish
    • 1
  • J. A. Johnson
    • 3
  1. 1.Department of MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Department of Emergency MedicineUniversity of AlbertaEdmontonCanada
  3. 3.School of Public HealthUniversity of AlbertaEdmontonCanada
  4. 4.Institute of Health EconomicsEdmontonCanada
  5. 5.Department of MedicineUniversity of CalgaryCalgaryCanada
  6. 6.2F1.24 Walter Mackenzie Health Sciences CentreUniversity of Alberta HospitalEdmontonCanada

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