Health Economics

Osteoporotic fractures are very common and extremely expensive

• Worldwide, an osteoporotic fracture is estimated to occur every 3 seconds, which amounts to almost 25 000 fractures per day or 9 million per year.
• These fractures cost 32 billion EUR per year in Europe and 20 billion USD per year in the United States.
• In China, as the population ages, the 1.6 billion USD spent on hip fracture care in 2006 is set to rise to 12.5 billion USD by 2020 and 265 billion USD by 2050. Similar changes are projected across Asia, Latin America and the Middle East.

In the prevailing global economic climate, robust demonstration of cost-effectiveness is a prerequisite if new models of care are to be broadly implemented. In a growing number of countries throughout the world, Fracture Liaison Services (FLS) have been shown to be highly cost-effective and in some healthcare systems, cost-saving.

A Cost-Benefit Analysis

The Glasgow FLS analysed the cost effectiveness of its FLS over the last 8 years during which they have been providing secondary fracture care in Glasgow, Scotland. From the results, it is estimated that implementing an FLS for the entire UK, it will cost just 0.6% of the current annual hip fracture costs. In summary:

FLS cohort of 686 patients, compared with 'usual care' cohort of 193 patients:

• 18 fewer fractures
• 3 life years gained
• 22 QALYs gained
• 266 hospital bed-days saved
• cost saving of 312 000 GBP (US $497 498) from fractures avoided

Read more about the cost-savings at the Glasgow FLS.

Modelling of the costs of second fractures and the impact of effective FLS are available at national, regional and local levels below.

Italy

• Pharmacological treatment of hip fractured patients in Italy: a simulation based on Tuscany regional database for the TARGET project. Piscitelli P, Metozzi A, Brandi ML, Nuti R, Rizzuti C, Orlandini E, Giorni L, Merlotti D. Clin Cases Miner Bone Metab. 2010 May;7(2):140-143. PubMed ID 22460020

United Kingdom

• Fracture prevention services: an economic evaluation. Department of Health. 2009.
• Benefits Calculator: FLS Implementation Toolkit. National Osteoporosis Society. 2015.

United States of America

• Prevalence and costs of osteoporotic patients with subsequent non-vertebral fractures in the US. Pike CT, Birnbaum HG, Schiller M, Swallow E, Burge RT, Edgell ET. Osteoporos Int. 2011 Oct;22(10):2611-2621. PubMed ID 21107532
• Cost burden of second fracture in the US health system. Song X, Shi N, Badamgarav E, Kallich J, Varker H, Lenhart G, Curtis JR. Bone. 2011 Apr 1;48(4):828-836. PubMed ID 21211578

Publications describing successful programmes from the following countries provide visitors with practical insights regarding how effective models of care have been established throughout the world.

Australia

Concord Repatriation General Hospital, Sydney, New South Wales

• Cost-effectiveness of the Concord Minimal Trauma Fracture Liaison service, a prospective, controlled fracture prevention study. Cooper MS, Palmer AJ, Seibel MJ. Osteoporos Int. Jan 2012;23(1):97-107. PubMed ID 21953475

Canada

Edmonton Hospitals, Alberta

• Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Majumdar SR, Lier DA, Beaupre LA, Hanley DA, Maksymowych WP, Juby AG, Bell NR, Morrish DW. Arch Intern Med. 2009 Jan 12;169(1):25-31. PubMed ID 19139320

St. Michael’s Hospital, Toronto, Ontario

• A coordinator program in post-fracture osteoporosis management improves outcomes and saves costs. Sander B, Elliot-Gibson V, Beaton DE, Bogoch ER, Maetzel A. J Bone Joint Surg Am. Jun 2008;90(6):1197-1205. PubMed ID 18519311

United Kingdom

Glasgow University Hospitals, Scotland

• Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L, Adekunle F, Roberts D. Osteoporos Int. 2011 Jul;22(7):2083-2098. PubMed ID 21607809

United States of America

Geisinger Health System, Pennsylvania

• Osteoporosis disease management in a rural health care population: hip fracture reduction and reduced costs in postmenopausal women after 5 years. Newman ED, Ayoub WT, Starkey RH, Diehl JM, Wood GC. Osteoporos Int. 2003 Apr;14(2):146-151. PubMed ID 12730773

Kaiser Permanente, Southern California

• Osteoporosis disease management: the role of the orthopaedic surgeon. Dell R, Greene D, Schelkun SR, Williams K. J Bone Joint Surg Am. Nov 2008;90 Suppl 4:188-194. PubMed ID 18984730