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Return on investment of fracture liaison services: a systematic review and analysis

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Abstract

Fracture liaison services (FLS) have been proven clinically effective and cost-effective in preventing subsequent fractures among patients with an existing fragility fracture. Little is known about their monetary benefits such as their return on investment (ROI). This systematic review aimed to investigate the ROI of FLS and identify the FLS characteristics with better ROI. Studies on the cost-effectiveness of FLS published between January 2000 and December 2022 were searched from MEDLINE, EMBASE, PubMed, and Cochrane Central. Two independent reviewers conducted study selection and data extraction. ROI was calculated based on the difference between monetary benefits and FLS costs divided by the FLS costs. Subgroup analysis of ROI was performed across FLS types and FLS design details. A total of 23 FLS were included in this review. The majority of them were targeting patients aged over 50 years having fractures without identified sites. The mean ROI of these FLS was 10.49 (with a median ROI of 7.57), and 86.96% of FLS had positive ROI. FLS making treatment recommendations yielded the highest ROI (with a mean ROI of 18.39 and a median of 13.60). Incorporating primary care providers (with a mean ROI of 16.04 and a median of 13.20) or having them as program leaders (with a mean ROI of 12.07 and a median of 12.07) has demonstrated a high ROI. FLS for specific fracture sites had great monetary return. Intensive FLS such as type A and B FLS programs had higher ROI than non-intensive type C and D FLS. This review revealed a 10.49-fold monetary return of FLS. Identified characteristics contributing to greater economic return informed value-for-money FLS designs. Findings highlight the importance of FLS and the feasibility of expanding their contribution in mitigating the economic burden of osteoporotic fracture and are conducive to the promotion of FLS internationally.

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Funding

The study is funded by an MRFF grant (APP1176600). Lizheng Xu is supported by an Australian Government Research Training Program Scholarship.

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Authors and Affiliations

  1. The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia

    L. Xu, S. Wang & S. Jan

  2. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia

    T. Zhao

  3. Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia

    L. Perry

  4. South Eastern Sydney Local Health District, Randwick, New South Wales, Australia

    L. Perry

  5. University of Wollongong and South Western Sydney Local Health District, Wollongong, New South Wales, Australia

    S.A. Frost

  6. Department of Business Economics, Health & Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland

    G.L. Di Tanna

  7. School of Health Policy and Management, Nanjing Medical University, No. 101, Longmian Avenue, Nanjing, 211166, China

    M. Chen

  8. School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia

    G.S. Kolt & L. Si

  9. Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia

    L. Si

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Xu, L., Zhao, T., Perry, L. et al. Return on investment of fracture liaison services: a systematic review and analysis. Osteoporos Int 35, 951–969 (2024). https://doi.org/10.1007/s00198-024-07027-2

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