Cost-effectiveness of the Concord Minimal Trauma Fracture Liaison service, a prospective, controlled fracture prevention study

Summary We evaluated the cost-effectiveness of a fractureliaison service prospectively designed to have a parallelcontrol group treated by standard care. The clinicaleffectiveness of this service was associated with anincremental cost-effectiveness ratio versus standard care ofAustralian dollars (AUD) 17,291 per quality-adjusted lifeyear (QALY) gained.Introduction Osteoporotic fractures are a major burden fornational health services. The risk of re-fracture following anosteoporotic fracture is particularly high. In a study unique inprospectively having a control group treated by standard care,we recently demonstrated that a Minimal Trauma FractureLiaison (MTFL) service significantly reduces the risk of refractureby 80%. Since the service involves greater use ofresources, we have now evaluated whether it is cost-effective.Methods A Markov model was developed that incorporatedfracture probabilities and resource utilization data (expressedin AUD) obtained directly from the 4-year MTFL serviceclinical study. Resource utilization, local cost and mortalitydata and fracture-related health utility data were used tocalculate QALYs with the MTFL service and standardcare. Main outcome measures were: additional costs ofthe MTFL service over standard care, the financialsavings achieved through reduced fractures and changesin QALYs associated with reduced fractures calculatedover a 10-year simulation period. Costs and QALYs werediscounted at 5% annually. Sensitivity analyses quantified theeffects of different assumptions of effectiveness and resourceutilization associated with the MTFL service.Results The MTFL service improved QALYs by0.089 years and led to increased costs of AUD 1,486 perpatient versus standard care over the 10-year simulationperiod. The incremental cost-effectiveness ratio versusstandard care was AUD 17,291 per QALY gained. Resultswere robust under all plausible assumptions.Conclusions The MTFL service is a cost-effective interventionto reduce recurrent osteoporotic fractures.