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Osteoporosis International
Published in: Osteoporosis International 7/2011

01-07-2011 | Original Article

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

Authors: A. R. McLellan, S. E. Wolowacz, E. A. Zimovetz, S. M. Beard, S. Lock, L. McCrink, F. Adekunle, D. Roberts

Published in: Osteoporosis International | Issue 7/2011

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Abstract

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.
Appendix
Available only for authorised users
Footnotes
1
In an audit of the Glasgow Direct Access DXA Service, GPs instituted the recommended treatment in 96% of cases and another treatment in most remaining cases. In a survey of patients recommended treatment by the Glasgow FLS 6 to 12 months after initiation of therapy, of the 66% of those who responded, 86% to 88% indicated they were taking the recommended treatment.
 
Literature
1.
McLellan AR, Gallacher SJ, Fraser M, McQuillian C (2003) The FLS: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14:1028–1034PubMedCrossRef
2.
3.
4.
5.
6.
McLellan AR, Reid DM, Forbes K, Reid R, Campbell C, Gregori A, Raby N, Simpson A (2004) Effectiveness of strategies for the secondary prevention of osteoporotic fractures in Scotland, an audit funded by NHS Quality Improvement Scotland (Project CEPS 99/03). http://​www.​nhshealthquality​.​org/​nhsqis/​2755.​html. Accessed 2 November 2009
7.
8.
9.
Fraser M, McLellan AR (2004) A fracture liaison service for patients with osteoporotic fractures. Prof Nurse 19(5):286–290PubMed
10.
11.
12.
Majumdar SR, Johnson JA, Lier DA et al (2007) Persistence, reproducibility, and cost-effectiveness of an intervention to improve the quality of osteoporosis care after a fracture of the wrist: results of a controlled trial. Osteoporos Int 18(3):261–270PubMedCrossRef
13.
Majumdar SR, Lier DA, Beaupre LA et al (2009) Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch Intern Med 169(1):25–31PubMedCrossRef
14.
Sander B, Elliot-Gibson V, Beaton D, Bogoch ER, Maetzel A (2008) A coordinator program in post-fracture osteoporosis management improves outcomes and saves costs. J Bone Joint Surg 90:1197–1205PubMedCrossRef
15.
Dell R, Greene D, Schelkun SR, Williams K (2008) Osteoporosis disease management: the role of the orthopaedic surgeon. J Bone Joint Surg 90(suppl 4):188–194PubMedCrossRef
16.
17.
18.
19.
20.
Bucher HC, Guyatt GH, Griffith LE, Walter SD (1997) The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol 50:683–691PubMedCrossRef
21.
Robinson CM, Royds M, Abraham A, McQueen MM, Court-Brown CM, Christie J (2002) Refractures in patients at least forty-five years old. a prospective analysis of twenty-two thousand and sixty patients. J Bone Joint Surg Am 84-A(9):1528–1533PubMed
22.
23.
Kanis JA, Brazier J, Stevenson M, et al. (2002) Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 6(29)
24.
Office for National Statistics (2008) Mortality rates 2001, deaths 2001: rates per 1000 population by age-group and sex in the UK. Taken from Table 6 published in Mortality Statistics, General, 2001 (series DH1 No. 34). http://​www.​statistics.​gov.​uk/​statbase. Accessed 14 September 2009
25.
Stevenson M, Lloyd JM, De NE (2005) A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. Systematic review. Health Technol Assess 9:1–160PubMed
26.
Peasgood T, Herrmann K, Kanis JA, Brazier JE (2009) An updated systematic review of health state utility values for osteoporosis related conditions. Osteoporos Int 20(6):853–868PubMedCrossRef
27.
28.
29.
30.
31.
32.
Stevenson MD, Davis SE, Kanis JA (2006) The hospitalisation costs and out-patient costs of fragility fractures. Womens Health Med 3(4):149–151CrossRef
Metadata
Title
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
Authors
A. R. McLellan
S. E. Wolowacz
E. A. Zimovetz
S. M. Beard
S. Lock
L. McCrink
F. Adekunle
D. Roberts
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 7/2011
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-011-1534-0

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