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Osteoporosis International

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01-08-2020 | Original Article

Cost-effectiveness of a multidisciplinary co-management program for the older hip fracture patients in Beijing

Authors: K. Peng, M. Yang, M. Tian, M. Chen, J. Zhang, X. Wu, R. Ivers, L. Si

Published in: Osteoporosis International | Issue 8/2020

Abstract

Summary

The multidisciplinary co-management program for geriatric patients with hip fracture is cost-effective in the Chinese population and it has the potential to be scaled up in China.

Introduction

The study aimed to investigate the cost-effectiveness of a multidisciplinary co-management program for patients with hip fracture in China.

Methods

Hip fracture patients who were admitted to an orthopedic hospital in Beijing were included in the multidisciplinary co-management program. The cost-effectiveness of intervention was evaluated compared to the conventional management. A Markov microsimulation model was developed to simulate lifetime costs and effectiveness. Costs including intervention, hospitalization, medications, and long-term care costs were expressed using 2019 US dollars and the healthcare perspective was adopted. Effectiveness was evaluated using both 1-year mortality-averted and quality-adjusted life years (QALYs). Costs and effectiveness were discounted at 5% per annum. The willingness-to-pay (WTP) threshold was set at $26,481 per QALY gained which was three times gross domestic product (GDP) per capita in China. One-way and probabilistic sensitivity analyses were conducted.

Results

The lifetime cost for the conventional management (n = 1839) and intervention group (n = 1192) was $11,975 and $13,309 respectively. The lifetime QALYs were 2.38 and 2.45 years and the first-year mortality was 17.8% and 16.1%. The incremental cost-effectiveness ratio was $19,437 per QALY gained or $78,412 per 1-year mortality-averted. Given the Chinese WTP threshold, the intervention had a 78% chance being cost-effective. The cost-effectiveness of the intervention was sensitive to cost of intervention and the proportion of patients who underwent surgery within 48 h.

Conclusions

The multidisciplinary co-management program for patients with hip fracture is cost-effective and it has the potential to be scaled up in the Chinese population.

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Williamson S, Landeiro F, McConnell T, Fulford-Smith L, Javaid MK, Judge A, Leal J (2017) Costs of fragility hip fractures globally: a systematic review and meta-regression analysis. Osteoporos Int 28:2791–2800PubMedCrossRef

Si L, Winzenberg TM, de Graaff B, Palmer AJ (2014) A systematic review and meta-analysis of utility-based quality of life for osteoporosis-related conditions. Osteoporos Int 25:1987–1997PubMedCrossRef

Mohd-Tahir N, Li S (2017) Economic burden of osteoporosis-related hip fracture in Asia: a systematic review. Osteoporos Int 28:2035–2044PubMedCrossRef

Qu B, Ma Y, Yan M, Wu H-H, Fan L, Liao D-F, Pan X-M, Hong Z (2014) The economic burden of fracture patients with osteoporosis in western China. Osteoporos Int 25:1853–1860PubMedCrossRef

Si L, Winzenberg T, Jiang Q, Chen M, Palmer A (2015) Projection of osteoporosis-related fractures and costs in China: 2010–2050. Osteoporos Int 26:1929–1937PubMedCrossRef

McLellan AR, Gallacher SJ, Fraser M, McQuillian C (2003) The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14:1028–1034PubMedCrossRef

Moja L, Piatti A, Pecoraro V, Ricci C, Virgili G, Salanti G, Germagnoli L, Liberati A, Banfi GJPo (2012) Timing matters in hip fracture surgery:patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One 7(10):e46175

Tsang C, Boulton C, Burgon V, Johansen A, Wakeman R, Cromwell DA (2017) Predicting 30-day mortality after hip fracture surgery: evaluation of the National Hip Fracture Database case-mix adjustment model. Bone & Joint Research 6:550–556CrossRef

Physicians RCo (2016) National Hip Fracture Database Annual Report 2016. RCP, London

10.

Simunovic N, Devereaux P, Sprague S, Guyatt GH, Schemitsch E, DeBeer J, Bhandari M (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. Cmaj 182:1609–1616PubMedPubMedCentralCrossRef

11.

Liu S, Ho A, Wong S (2017) Early surgery for Hong Kong Chinese elderly patients with hip fracture reduces short-term and long-term mortality. Hong Kong Med J 23:374–380PubMed

12.

Australian, Group NZHFRS (2014) Australian and New Zealand guideline for hip fracture care: improving outcomes in hip fracture management of adults. Australian and New Zealand Hip Fracture Registry Steering Group Sydney

13.

National Institute for Health and Care Excellence (2011) Hip fracture: the management of hip fracture in adults

14.

Tian M, Gong X, Rath S, Wei J, Yan L, Lamb S, Lindley R, Sherrington C, Willett K, Norton R (2016) Management of hip fractures in older people in Beijing: a retrospective audit and comparison with evidence-based guidelines and practice in the UK. Osteoporos Int 27:677–681PubMedCrossRef

15.

Kalmet PH, Koc BB, Hemmes B et al (2016) Effectiveness of a multidisciplinary clinical pathway for elderly patients with hip fracture: a multicenter comparative cohort study. Geriatr Orthop Surg Rehabil 7:81–85PubMedPubMedCentralCrossRef

16.

Wallace R, Angus LDG, Munnangi S, Shukry S, DiGiacomo JC, Ruotolo C (2019) Improved outcomes following implementation of a multidisciplinary care pathway for elderly hip fractures. Aging Clin Exp Res 31:273–278PubMedCrossRef

17.

Wu X, Tian M, Zhang J, Yang M, Gong X, Liu Y, Li X, Lindley RI, Anderson M, Peng K (2019) The effect of a multidisciplinary co-management program for the older hip fracture patients in Beijing: a “pre-and post-” retrospective study. Arch Osteoporos 14:43PubMedCrossRef

18.

Pitzul KB, Wodchis WP, Kreder HJ, Carter MW, Jaglal SB (2017) Discharge destination following hip fracture: comparative effectiveness and cost analyses. Arch Osteoporos 12:87PubMedCrossRef

19.

Leal J, Gray AM, Hawley S, Prieto-Alhambra D, Delmestri A, Arden NK, Cooper C, Javaid MK, Judge A (2017) Cost-effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: a population-based study. J Bone Miner Res 32:203–211PubMedCrossRef

20.

Darowski A (2007) The Care of Patients with fragility fracture (“blue book”). British Orthopaedic Association

21.

Komorowski M, Raffa J (2016) Markov models and cost effectiveness analysis: applications in medical research. In: Data MITC (ed) Secondary analysis of electronic health records. Springer International Publishing, Cham, pp 351–367CrossRef

22.

Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. Jama 301:513–521PubMedCrossRef

23.

Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. Jama 297:387–394PubMedCrossRef

24.

Ling X, Aimin L, Xihe Z, Xiaoshu C, Cummings SR (1996) Very low rates of hip fracture in Beijing, People’s Republic of China: the Beijing Osteoporosis Project. Am J Epidemiol 144:901CrossRef

25.

Xia WB, He SL, Xu L, Liu AM, Jiang Y, Li M, Wang O, Xing XP, Sun Y, Cummings SR (2012) Rapidly increasing rates of hip fracture in Beijing, China. J Bone Miner Res 27:125–129PubMedCrossRef

26.

Ge X, Wang J, Liu B, Qin W (2008) Advances of rehabilitation nursing of patients following surgery of hip fractures. Chin J Nurs 43(6):550–553

27.

Liu G, Hu S, Wu J, Wu J, Yang L, Li HJCPE (2011) China guidelines for pharmacoeconomic evaluations. (3), 8–11, 13–50

28.

Li M, Zhang Y, Zhang Z, Zhang Y, Zhou L, Chen K (2013) Rural-urban differences in the long-term care of the disabled elderly in China. PLoS One 8:e79955PubMedPubMedCentralCrossRef

29.

Si L, Shi L, Chen M, Palmer AJ (2017) Establishing benchmark EQ-5D-3L population health state utilities and identifying their correlates in Gansu Province, China. Qual Life Res 26:3049–3058PubMedCrossRef

30.

Compston J, Cooper A, Cooper C, Gittoes N, Gregson C, Harvey N, Hope S, Kanis J, McCloskey E, Poole KE (2017) UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 12(1):43PubMedPubMedCentralCrossRef

31.

Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Robinson V, Coyle D, Tugwell P (2008) Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev Cd001155

32.

Cai Z (2017) Research in rehabilitation nursing of postoperative limb function recovery in elderly patients with hip fracture. Today Nurse Journal:3–5

33.

(2011) China Guidelines for Pharmacoeconomic Evaluations

34.

China NBoSo (2019) Income and expenditure http://www.stats.gov.cn/tjsj/zxfb/201901/t20190121_1645791.html 2019

35.

Briggs AH, Weinstein MC, Fenwick EA, Karnon J, Sculpher MJ, Paltiel AD (2012) Model parameter estimation and uncertainty analysis: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force Working Group-6. Med Decis Mak 32(5):722–732CrossRef

36.

Yu SF, Chou CL, Lai HM, Chen YC, Chiu CK, Kuo MC, Su YJ, Chen CJ, Cheng TT (2012) Adherence to anti-osteoporotic regimens in a southern Taiwanese population treated according to guidelines: a hospital-based study. Int J Rheum Dis 15:297–305PubMedCrossRef

37.

Hiligsmann M, Reginster JY, Tosteson ANA, et al. (2018) Recommendations for the conduct of economic evaluations in osteoporosis: outcomes of an experts' consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the US branch of the international Osteoporosis Foundation. Osteoporos Int

38.

Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E (2013) Consolidated health economic evaluation reporting standards (CHEERS) statement. Value Health 16:e1–e5PubMedCrossRef

39.

Majumdar SR, Lier DA, Beaupre LA, Hanley DA, Maksymowych WP, Juby AG, Bell NR, Morrish DW (2009) Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch Intern Med 169:25–31PubMedCrossRef

40.

Cooper MS, Palmer AJ, Seibel MJ (2012) Cost-effectiveness of the concord minimal trauma fracture liaison service, a prospective, controlled fracture prevention study. Osteoporos Int 23:97–107PubMedCrossRef

41.

Swart E, Vasudeva E, Makhni EC, Macaulay W, Bozic KJ (2016) Dedicated perioperative hip fracture comanagement programs are cost-effective in high-volume centers: an economic analysis. Clinical Orthopaedics & Related Research® 474:222–233CrossRef

42.

Dy CJ, McCollister KE, Lubarsky DA, Lane JM (2011) An economic evaluation of a systems-based strategy to expedite surgical treatment of hip fractures. JBJS 93:1326–1334CrossRef

43.

Klestil T, Röder C, Stotter C, Winkler B, Nehrer S, Lutz M, Klerings I, Wagner G, Gartlehner G, Nussbaumer-Streit B (2018) Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis. Sci Rep 8:13933PubMedPubMedCentralCrossRef

44.

Fatoye F, Smith P, Gebrye T, Yeowell G (2019) Real-world persistence and adherence with oral bisphosphonates for osteoporosis: a systematic review. BMJ Open 9:e027049PubMedPubMedCentralCrossRef

45.

Soong YK, Tsai KS, Huang HY, Yang RS, Chen JF, Wu PC, Huang KE (2013) Risk of refracture associated with compliance and persistence with bisphosphonate therapy in Taiwan. Osteoporos Int 24:511–521PubMedCrossRef

46.

Scotti L, Arfè A, Zambon A, Merlino L, Corrao G (2014) Cost-effectiveness of enhancing adherence with oral bisphosphonates treatment in osteoporotic women: an empirical approach based on healthcare utilisation databases. BMJ Open 4:e003758PubMedPubMedCentralCrossRef

47.

Strom O, Borgstrom F, Kanis JA, Jonsson B (2009) Incorporating adherence into health economic modelling of osteoporosis. Osteoporos Int 20:23–34PubMedCrossRef

Title: Cost-effectiveness of a multidisciplinary co-management program for the older hip fracture patients in Beijing
Authors: K. Peng
M. Yang
M. Tian
M. Chen
J. Zhang
X. Wu
R. Ivers
L. Si
Publication date: 01-08-2020
Publisher: Springer London
Published in: Osteoporosis International / Issue 8/2020
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-020-05393-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Cost-effectiveness of a multidisciplinary co-management program for the older hip fracture patients in Beijing

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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