Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture

Osteoporos Int. 2011 Jun;22(6):1799-808. doi: 10.1007/s00198-010-1412-1. Epub 2010 Sep 29.

Abstract

In a randomized trial, a multifaceted intervention tripled rates of osteoporosis treatment in older patients with wrist fracture. An economic analysis of the trial now demonstrates that the intervention tested "dominates" usual care: over a lifetime horizon, it reduces fracture, increases quality-adjusted life years, and saves the healthcare system money.

Introduction: In a randomized trial (N = 272), we reported a multifaceted quality improvement intervention directed at older patients and their physicians could triple rates of osteoporosis treatment within 6 months of a wrist fracture when compared with usual care (22% vs 7%). Alongside the trial, we conducted an economic evaluation.

Methods: Using 1-year outcome data from our trial and micro-costing time-motion studies, we constructed a Markov decision-analytic model to determine cost-effectiveness of the intervention compared with usual care over the patients' remaining lifetime. We took the perspective of third-party healthcare payers. In the base case, costs and benefits were discounted at 3% and expressed in 2006 Canadian dollars. One-way deterministic and probabilistic sensitivity analyses were conducted.

Results: Median age of patients was 60 years, 77% were women, and 72% had low bone mineral density (BMD). The intervention cost $12 per patient. Compared with usual care, the intervention strategy was dominant: for every 100 patients receiving the intervention, three fractures (one hip fracture) would be prevented, 1.1 quality-adjusted life year gained, and $26,800 saved by the healthcare system over their remaining lifetime. The intervention dominated usual care across numerous one-way sensitivity analyses: with respect to cost, the most influential parameter was drug price; in terms of effectiveness, the most influential parameter was rate of BMD testing. The intervention was cost saving in 80% of probabilistic model simulations.

Conclusions: For outpatients with wrist fractures, our multifaceted osteoporosis intervention was cost-effective. Healthcare systems implementing similar interventions should expect to save money, reduce fractures, and gain quality-adjusted life expectancy.

Trial registration: ClinicalTrials.gov NCT00152321.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Alberta
  • Bone Density / physiology
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Epidemiologic Methods
  • Female
  • Health Care Costs / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Models, Econometric
  • Osteoporosis / complications
  • Osteoporosis / economics
  • Osteoporosis / physiopathology
  • Osteoporosis / therapy*
  • Osteoporotic Fractures / economics
  • Osteoporotic Fractures / physiopathology
  • Osteoporotic Fractures / prevention & control*
  • Quality Improvement / economics*
  • Quality Improvement / organization & administration
  • Quality-Adjusted Life Years
  • Secondary Prevention
  • Wrist Injuries / etiology*
  • Wrist Injuries / physiopathology

Associated data

  • ClinicalTrials.gov/NCT00152321