Cost‐Effectiveness of Osteoporosis Interventions to Improve Quality of Care After Upper Extremity Fracture: Results From a Randomized Trial (C‐STOP Trial)

• Published in: Journal of bone and mineral research Vol. 34; no. 7; pp. 1220 - 1228
• Main Authors: Majumdar, Sumit R, Lier, Douglas A, McAlister, Finlay A, Johnson, Jeffrey A, Rowe, Brian H, Beaupre, Lauren A
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2019
• Subjects: CLINICAL TRIALS; COST‐EFFECTIVENESS; FRACTURE PREVENTION; Fractures; Intervention; OSTEOPOROSIS; Patients; Quality of care; COST-EFFECTIVENESS; CLINICAL TRIALS; FRACTURE PREVENTION; OSTEOPOROSIS
• ISSN: 0884-0431; 1523-4681
• DOI: 10.1002/jbmr.3699

ABSTRACT We assessed the cost‐effectiveness of two models of osteoporosis care after upper extremity fragility fracture using a high‐intensity Fracture Liaison Service (FLS) Case‐Manager intervention versus a low‐intensity FLS (ie, Active Control), and both relative to usual care. This analysis used data from a pragmatic patient‐level parallel‐arm comparative effectiveness trial of 361 community‐dwelling participants 50 years or older with upper extremity fractures undertaken at a Canadian academic hospital. We used a decision‐analytic Markov model to evaluate the cost‐effectiveness of the three treatment alternatives. The perspective was health service payer; the analytical horizon was lifetime; costs and health outcomes were discounted by 3%. Costs were expressed in 2016 Canadian dollars (CAD) and the health effect was measured by quality adjusted life years (QALYs). The average age of enrolled patients was 63 years and 89% were female. Per patient cost of the Case Manager and Active Control interventions were $66CAD and $18CAD, respectively. Compared to the Active Control, the Case Manager saved $333,000, gained seven QALYs, and averted nine additional fractures per 1000 patients. Compared to usual care, the Case Manager saved $564,000, gained 14 QALYs, and incurred 18 fewer fractures per 1000 patients, whereas the Active Control saved $231,000, gained seven QALYs, and incurred nine fewer fractures per 1000 patients. Although both interventions dominated usual care, the Case Manager intervention also dominated the Active Control. In 5000 probabilistic simulations, the probability that the Case Manager intervention was cost‐effective was greater than 75% whereas the Active Control intervention was cost‐effective in less than 20% of simulations. In summary, although the adoption of either of these approaches into clinical settings should lead to cost savings, reduced fractures, and increased quality‐adjusted life for older adults following upper extremity fracture, the Case Manager intervention would be the most likely to be cost‐effective. © 2019 American Society for Bone and Mineral Research.