Oral Presentation Annual Meetings of the Endocrine Society of Australia and Society for Reproductive Biology and Australia and New Zealand Bone and Mineral Society 2016

Fracture liaison sevice (FLS) reduces re fracture rate and is cost effective and cost saving (#140)

Charles Inderjeeth 1 , Warren Raymond 1 , Elizabeth Geelhoed 2 , Andrew Briggs 3 , Kathy Briffa 3 , David Oldham 4 , Jean McQuade 5 , David Mountain
  1. North Metropolitan Health and University of Western Australia, Nedlands, WA, Australia
  2. Population Health, University of Western Australia, Perth, WA, Australia
  3. School of Physiotherapy, Curtin University, Perth, WA, Australia
  4. Sir Charles Gairdner Hospital, Perth, WA, Australia
  5. Arthritis and Osteoporosis WA, Perth, WA, Australia


Fractures result in significant healthcare costs. In Western Australia from 2002 to 2012, direct hospital costs attributable to MTFs exceeded AUD$100 million(1).



To determine the cost effectiveness of a simplified FLS established in a tertiary hospital identifying fracture patients over 50 years from an Emergency Medicine database (EDIS).


Study group:  FLS hospital (SCGHFLS). Control groups:  Retrospective comparator (SCGHR) and comparator hospital (FH).

Clinical and economic data collected at baseline, 3 and 12 months.

Outcome measures s: Recurrent fracture rates/1000 patient years. The quality-adjusted life-years (QALY) gained from EQ-5D weighted scores.

Health Economic Methodology: A bottom-up or “ingredients” approach to cost effectiveness from the Payer Perspective.  Calculated incremental cost-effectiveness ratio (ICER) (95% confidence interval). Cost-effectiveness acceptability curve for incremental levels of investment. Society’s willingness-to-pay (WTP) was set at $50,000 (cost of breast cancer screening).



Clinical characteristics were similar in three study groups: mean age 71 years, 72-89% female, similar fracture profile.

SCGHFLS had lower recurrent fracture rate at 12 months compared to the SCGHR and FH cohorts (8.9% vs 21.3% vs 20.3%, p<0.001); improvement in QOL measured by EQ-5D (+9%, -8%, -13%, p<0.001) and EQ-5D health state (VAS) (+16.5%, -2%, +1%, p<0.001).

The incremental cost of a 1% reduction in recurrent fracture rate compared to SCGHR and FH was $8,721 (- $1,218, $35,044) and $8,974 (- $26,701, $69,929) respectively. The incremental cost per QALY gained at 12 months was $293 (- $3,589, $3,381) and -$261 (-$1,541, $472) respectively. WTP of $16,000 the SCGHFLS will reduce the recurrent fracture rate by 1% compared to the SCGHR and FH service models, ie 10 recurrent fractures per 1000 patient-years.


The SCGHFLS reduced recurrent fracture rates (ARR 12%), improved QOL and was cost-effective with cost savings of approximately $986,200-$1,064,000 per 1,000 patient-years in the first year.

  1. Briggs, AM, et al., Hospitalisations, admission costs and re-fracture risk related to osteoporosis in Western Australia are substantial: a 10-year review. Australian and New Zealand Journal of Public Health, 2015. 39(6): p. 557-562.