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

• Published in: Osteoporosis international 2011-07, Vol.22 (7), p.2083-2098
• Main Authors: McLellan, A. R., Wolowacz, S. E., Zimovetz, E. A., Beard, S. M., Lock, S., McCrink, L., Adekunle, F., Roberts, D.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Bone Density; Bone Density Conservation Agents - economics; Bone Density Conservation Agents - therapeutic use; Cost-Benefit Analysis; Dietary Supplements - economics; Diphosphonates - economics; Diphosphonates - therapeutic use; Diseases of the osteoarticular system; Endocrinology; Female; Fractures; Health care expenditures; Hip Fractures - economics; Hip Fractures - prevention & control; Humans; Humeral Fractures - economics; Humeral Fractures - prevention & control; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Models, Economic; Original Article; Orthopedics; Osteoporosis; Osteoporosis - drug therapy; Osteoporosis - economics; Osteoporosis - mortality; Osteoporosis. Osteomalacia. Paget disease; Osteoporotic Fractures - economics; Osteoporotic Fractures - mortality; Osteoporotic Fractures - prevention & control; Preventive medicine; Quality of Life; Rheumatology; Risk Factors; Secondary Prevention - economics; Traumas. Diseases due to physical agents; United Kingdom; Wrist Injuries - economics; Wrist Injuries - prevention & control
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-011-1534-0

Summary The cost-effectiveness of Fracture Liaison Services (FLSs) for prevention of secondary fracture in osteoporosis patients in the United Kingdom (UK), and the cost associated with their widespread adoption, were evaluated. An estimated 18 fractures were prevented and £21,000 saved per 1,000 patients. Setup across the UK would cost an estimated £9.7 million. Introduction Only 11% to 28% of patients with a fragility fracture receive osteoporosis treatment in the UK. FLSs provide an efficient means to identify patients and are endorsed by the Department of Health but have not been widely adopted. The objective of this study was to evaluate the cost-effectiveness of FLSs in the UK and the cost associated with their widespread adoption. Methods A cost-effectiveness and budget-impact model was developed, utilising detailed audit data collected by the West Glasgow FLS. Results For a hypothetical cohort of 1,000 fragility-fracture patients (740 requiring treatment), 686 received treatment in the FLS compared with 193 in usual care. Assessments and osteoporosis treatments cost an additional £83,598 and £206,544, respectively, in the FLS; 18 fractures (including 11 hip fractures) were prevented, giving an overall saving of £21,000. Setup costs for widespread adoption of FLSs across the UK were estimated at £9.7 million. Conclusions FLSs are cost-effective for the prevention of further fractures in fragility-fracture patients. The cost of widespread adoption of FLS across the UK is small in comparison with other service provision and would be expected to result in important benefits in fractures avoided and reduced hospital bed occupancy.