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Economic impact and cost-effectiveness of fracture liaison services: a systematic review of the literature

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Abstract

Fracture liaison services (FLS), implemented in different ways and countries, are reported to be a cost-effective or even a cost-saving secondary fracture prevention strategy. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards. This study summarizes the economic impact and cost-effectiveness of FLS implemented to reduce subsequent fractures in individuals with osteoporosis. This systematic review identified studies reporting economic outcomes for FLS in osteoporotic patients aged 50 and older through a comprehensive search of MEDLINE, EMBASE, Cochrane Central, and PubMed of studies published January, 2000 to December, 2016. Grey literature (e.g., Google scholar, conference abstracts/posters) were also hand searched through February 2017. Two independent reviewers screened titles and abstracts and conducted full-text review on qualified articles. All disagreements were resolved by discussion between reviewers to reach consensus or by a third reviewer. In total, 23 qualified studies that evaluated the economic aspects of FLS were included: 16 cost-effectiveness studies, 2 cost-benefit analyses, and 5 studies of cost savings. Patient populations varied (prior fragility fracture, non-vertebral fracture, hip fracture, wrist fracture), and FLS strategies ranged from mail-based interventions to comprehensive nurse/physician-coordinated programs. Cost-effectiveness studies were conducted in Canada, Australia, USA, UK, Japan, Taiwan, and Sweden. FLS was cost-effective in comparisons with usual care or no treatment, regardless of the program intensity or the country in which the FLS was implemented (cost/QALY from $3023–$28,800 US dollars (USD) in Japan to $14,513–$112,877 USD in USA. Several studies documented cost savings. FLS, implemented in different ways and countries, are reported to be cost-effective or even cost-saving. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards.

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Acknowledgements

The authors would like to thank Dr. Zhongyun Zhao for facilitating this research and author collaborations.

Funding

This work was supported by the Amgen Inc. Writing and editorial assistance was provided by Sally Wade (Wade Outcomes Research and Consulting, Salt Lake City, UT, USA) and funded by the Amgen Inc., and a grant from the National Cheng Kung University College of Medicine and Hospital (NCKUH-10609007, 10605021).

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Authors and Affiliations

  1. Department of Family Medicine, National Cheng Kung University College of Medicine and Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan

    C.-H. Wu

  2. Orthopedic Department, Taitung Christian Hospital, No. 350, Kaifeng Street, Taitung City, Taitung County, 950, Taiwan

    I.-J. Kao & H.-C. Liu

  3. E-Da Hospital/I-Shou University, No.1, Yida Road, Yanchao District, Kaohsiung City, 824, Taiwan

    W.-C. Hung

  4. Orthopedic Department, Chung Shan Medical University, No.110, Section1, Jianguo North Road, Taichung City, Taiwan

    S.-C. Lin

  5. Department of Orthopedics, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, No.2, Min-Sheng Road, Dalin Town, Chia-Yi, Taiwan

    M.-H. Hsieh

  6. Complete HEOR Solutions LLC, 1046 Knapp Road, North Wales, PA, 19454, USA

    S. Bagga & M. Achra

  7. Chang Gung Memorial Hospital, No.123 Tapei Road, Niao-Sung District, Kaohsiung, Taiwan

    T.-T. Cheng

  8. Department of Orthopaedics, National Taiwan University and Hospital, No. 7, Chung-Shan S. Road, Taipei, Taiwan

    R.-S. Yang

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Conflicts of interest

This study was sponsored by the Amgen Inc., Thousand Oaks, CA.

HCW, WCH, SCL, HCL, MHH, MA, TTC, and RSY have no conflicts of interest to declare. IJK is a board member of Taiwan Osteoporosis Association. SB has ownership in the Complete HEOR Solutions LLC.

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Wu, CH., Kao, IJ., Hung, WC. et al. Economic impact and cost-effectiveness of fracture liaison services: a systematic review of the literature. Osteoporos Int 29, 1227–1242 (2018). https://doi.org/10.1007/s00198-018-4411-2

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