title: Cost-effectiveness of two inexpensive postfracture osteoporosis interventions: results of a randomized trial.
abstract: BACKGROUND
  Most older patients are not treated for osteoporosis after fragility fracture. In a 3-armed randomized trial, we reported that 2 inexpensive mail-based interventions, one directed at physicians and the other at physicians plus patients, increased 1-year osteoporosis treatment starts by 4% and 6% (respectively) compared with usual care starts of 11%. The cost-effectiveness of these interventions is unknown.
  
  
  METHODS
  The incremental cost-effectiveness of interventions compared with usual care was assessed using Markov decision-analytic models. Costs were expressed in 2010 Canadian dollars and long-term effectiveness based on quality-adjusted life years (QALYs) gained derived from hypothetical model simulations. The perspective was third-party health care payer; the time horizon was lifetime; and the costs and benefits were discounted 3%.
  
  
  RESULTS
  The physician intervention cost was $7.12 per patient, whereas the physician plus patient intervention cost was $8.45. Compared with usual care, the economic simulation demonstrated that for every 1000 patients getting the physician intervention, there were 2 fewer fractures, 2 more QALYs gained, and $22,000 saved. Compared with physician intervention, the simulation demonstrated that for every 1000 patients receiving physician plus patient intervention, there was 1 fewer fracture and 1 more QALY gained, with $18,000 saved. Both interventions dominated usual care and were cost saving or highly cost effective in 67% of 10 000 probabilistic simulations. Although the physician plus patient intervention cost was $1.33 more per patient than the physician intervention, it was still the most economically attractive option.
  
  
  CONCLUSIONS
  Pragmatic mail-based interventions directed at patients with recent fractures and their physicians are a highly cost-effective means to improving osteoporosis management and both interventions dominated usual care.
authors.affiliation: Department of Medicine, University of Alberta, and the Institute of Health Economics, Edmonton, Alberta, Canada T6G 2B7.
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Lier
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D008350:Manitoba; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D010024:Osteoporosis / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D058866:Osteoporotic Fractures / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care; D011177:Postal Service; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000191:economics; D019057:Quality-Adjusted Life Years