Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture.
In a randomized trial, a multifaceted intervention tripled rates of osteoporosis treatment in older patients with wrist fracture. An economic analysis of the trial now demonstrates that the intervention tested "dominates" usual care: over a lifetime horizon, it reduces fracture, increases quality-adjusted life years, and saves the healthcare system money.


BACKGROUND
In a randomized trial (N = 272), we reported a multifaceted quality improvement intervention directed at older patients and their physicians could triple rates of osteoporosis treatment within 6 months of a wrist fracture when compared with usual care (22% vs 7%). Alongside the trial, we conducted an economic evaluation.


METHODS
Using 1-year outcome data from our trial and micro-costing time-motion studies, we constructed a Markov decision-analytic model to determine cost-effectiveness of the intervention compared with usual care over the patients' remaining lifetime. We took the perspective of third-party healthcare payers. In the base case, costs and benefits were discounted at 3% and expressed in 2006 Canadian dollars. One-way deterministic and probabilistic sensitivity analyses were conducted.


RESULTS
Median age of patients was 60 years, 77% were women, and 72% had low bone mineral density (BMD). The intervention cost $12 per patient. Compared with usual care, the intervention strategy was dominant: for every 100 patients receiving the intervention, three fractures (one hip fracture) would be prevented, 1.1 quality-adjusted life year gained, and $26,800 saved by the healthcare system over their remaining lifetime. The intervention dominated usual care across numerous one-way sensitivity analyses: with respect to cost, the most influential parameter was drug price; in terms of effectiveness, the most influential parameter was rate of BMD testing. The intervention was cost saving in 80% of probabilistic model simulations.


CONCLUSIONS
For outpatients with wrist fractures, our multifaceted osteoporosis intervention was cost-effective. Healthcare systems implementing similar interventions should expect to save money, reduce fractures, and gain quality-adjusted life expectancy.
Majumdar
S R
SR
Department of Medicine, University of Alberta, Edmonton, AB, Canada. me2.majumdar@ualberta.ca
Lier
D A
DA
Rowe
B H
BH
Russell
A S
AS
McAlister
F A
FA
Maksymowych
W P
WP
Hanley
D A
DA
Morrish
D W
DW
Johnson
J A
JA
D000368:Aged; D000416:Alberta; D015519:Bone Density / Q000502:physiology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004812:Epidemiologic Methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D010024:Osteoporosis / Q000150:complications / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D058866:Osteoporotic Fractures / Q000191:economics / Q000503:physiopathology / Q000517:prevention & control*; D058996:Quality Improvement / Q000191:economics* / Q000458:organization & administration; D019057:Quality-Adjusted Life Years; D055502:Secondary Prevention; D014954:Wrist Injuries / Q000209:etiology* / Q000503:physiopathology