title: Economic evaluation of a population-based osteoporosis intervention for outpatients with non-traumatic non-hip fractures: the "Catch a Break" 1i [type C] FLS.
abstract: Fracture liaison services (FLS) are advocated to improve osteoporosis treatment after fragility fracture, but there are few economic analyses of different models. A population-based 1i [=type C] FLS for non-hip fractures was implemented and it costs $44 per patient and it was very cost-effective ($9200 per QALY gained). Small operational changes would convert it from cost-effective to cost-saving.
  
  
  
  After fragility fracture, <20% of patients receive osteoporosis treatment. FLS are recommended to address this deficit but there are very few economic analyses of different FLS models. Therefore, we conducted an economic analysis of a 1i (=type C) FLS called "Catch a Break (CaB)."
  
  
  
  CaB is a population-based FLS in Alberta, Canada, that case-finds older outpatients with non-traumatic upper extremity, spine, pelvis, or "other" non-hip fractures and provides telephonic outreach and printed educational materials to patients and their physicians. Cost-effectiveness was assessed using Markov decision-analytic models. Costs were expressed in 2014 Canadian dollars and effectiveness based on model simulations of recurrent fractures and quality-adjusted life years (QALYs). Perspective was healthcare payer; horizon was lifetime; and costs and benefits were discounted 3%.
  
  
  
  Over 1 year, CaB enrolled 7323 outpatients (mean age 67 years, 75% female, 69% upper extremity) at average cost of $44 per patient. Compared with usual care, CaB increased rates of bisphosphonate treatment by 4.3 to 17.5% (p < 0.001). Over their lifetime, for every 10,000 patients enrolled in CaB, 4 hip fractures (14 fractures total) would be avoided and 12 QALYs gained. Compared with usual care, incremental cost-effectiveness of CaB was estimated at $9200 per QALY. CaB was cost-effective in 85% of 10,000 probabilistic simulations. Sensitivity analyses showed if "other" fractures were excluded and intervention costs reduced 25% that CaB would become cost-saving.
  
  
  
  A relatively inexpensive population-based 1i (=type C) FLS was implemented in Alberta and it was very cost-effective. If CaB excluded "other" fractures and decreased intervention costs by 25%, it would be cost-saving, as would any FLS that was more effective and less expensive.
authors.affiliation: The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134 Clinical Sciences Building, 11350 - 83rd Avenue, Edmonton, Alberta, T6G 2G3, Canada. me2.majumdar@ualberta.ca.
authors.forename: S R
authors.initials: SR
authors.lastname: Majumdar
authors.affiliation: The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134 Clinical Sciences Building, 11350 - 83rd Avenue, Edmonton, Alberta, T6G 2G3, Canada.
authors.forename: D A
authors.initials: DA
authors.lastname: Lier
authors.affiliation: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
authors.forename: D A
authors.initials: DA
authors.lastname: Hanley
authors.affiliation: The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134 Clinical Sciences Building, 11350 - 83rd Avenue, Edmonton, Alberta, T6G 2G3, Canada.
authors.forename: A G
authors.initials: AG
authors.lastname: Juby
authors.affiliation: The Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
authors.forename: L A
authors.initials: LA
authors.lastname: Beaupre
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D004164:Diphosphonates / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D010024:Osteoporosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Cost-effectiveness analysis; Fracture liaison services; Fragility fracture; Guidelines; Osteoporosis treatment; Quality improvement