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.