Background Osteoporotic fractures impose significant morbidity, mortality and economic burden (1). Earlier research showed low rates of secondary prevention for patients discharged from Emergency Department (ED) with a fracture (2). The Fracture Liaison Service (FLS) aimed to identify, review and then manage these patients following their discharge from the ED.
Objectives Determine the economic benefits of a FLS in a Western Australian hospital.
Methods Patients aged >50yrs whom presented to the Emergency Department at Sir Charles Gairdner Hospital (SCGH) after a fracture were invited to the FLS. A retrospective control group from SCGH and a prospective control group from Fremantle Hospital were the comparators.
A health economic analysis from the Payer's Perspective (WA Health) examined recurrent fracture rates and quality of life (EQ-5D). Bottom-up costing included medications, investigations, GP visits and the cost of fracture determined by the literature or the AR-DRG 2013/14 prices for hospital presentation and admission. The mean incremental cost effectiveness ratios were bootstrapped (5000 iterations). Cost-effectiveness acceptability curves were generated and the willingness-to-pay was $50,000AUD.
Results This FLS reduced the rate of re-fracture compared to the retrospective cohort and other tertiary centre by 9.2 - 10.2%, equating to cost savings of approximately $750,168 - $810,400/1,000 patient-years in the first year compared to control cohorts. There was no difference in the QALYs gained across groups over 12 months.
The FLS compared to SCGH retrospective cohort had a mean incremental cost of $6,168 (95CI $133, $18,626) per 1% reduction in the 12 month recurrent fracture risk. The FLS compared to other sites had a mean incremental cost of $6,782 (95CI -$2,562, $25,686) per 1% reduction in the 12 month recurrent fracture risk. The FLS compared to SCGH retrospective cohort had a mean incremental cost of $859 (95CI -$4,074, $4,864) per QALY gained at 12 months. The FLS compared to other sites had a mean incremental cost of -$119 (95CI -$1,665, $700) per QALY gained at 12 months.
Figure 1 demonstrates that the FLS is cost-effective in delivering a reduction in the fracture rate at 12 months. However, the QALY gained (EQ-5D) was no different at 12 months between the study groups.
Conclusions This FLS demonstrated to be effective in reducing rates or recurrent fracture(s) and resulted in significant cost effectiveness and cost-saving.
Briggs AM et al.(2015) Hospitalisations, admission costs and re-fracture risk related to osteoporosis in Western Australia are substantial: a 10-year review. ANZ J Public Health.
Inderjeeth CA et al. (2010) A multimodal intervention to improve fragility fracture management in patients presenting to Emergency Departments. MJA
Disclosure of Interest None declared