A 3i hip fracture liaison service with nurse and physician co-management is cost-effective when implemented as a standar
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ORIGINAL ARTICLE
A 3i hip fracture liaison service with nurse and physician co-management is cost-effective when implemented as a standard clinical program L. A. Beaupre 1 & D. Lier 2 & C. Smith 3 & L. Evens 3 & H. M. Hanson 4,5 & A. G. Juby 6 & P. Kivi 7 & S. R. Majumdar 2 & On behalf of the STOP-Fracture Team Received: 23 April 2020 / Accepted: 30 June 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary A hip fracture liaison service that was implemented in 2 hospitals in Alberta, Canada, co-managed by a nurse and physician, was cost-effective and improved initiation of osteoporosis medication following hip fracture. Purpose/introduction To determine cost-effectiveness of a 3i hip fracture liaison service (H-FLS) with 12-month follow-up, comanaged by a nurse and physician, when implemented into standard practice. Methods The cost-effectiveness analysis compared those receiving the H-FLS to a simulated usual care group using a decision analytic model that incorporated Markov processes. We estimated incremental costs and effectiveness (based on quality-adjusted life years (QALYs) gained) using a lifetime horizon and a healthcare payer perspective. The H-FLS program provided data regarding population at risk, treatment rates, persistence, and intervention costs. We also performed deterministic and probabilistic sensitivity analyses. Results One thousand two hundred fifty-two patients were included in the H-FLS between June 2015 and March 2018; 69% were female; the average age was 80 ± 11 years. Anti-absorptive treatment following fracture was initiated in 59.6% (95% CI: 55.7–63.5) H-FLS patients relative to 20.9% (95% CI: 13.3–28.5%) receiving usual care (from our published work). Based on modeled cohort simulation cost-effectiveness analysis (CEA), every 1000 H-FLS patients would experience 12 fewer hip fractures and 37 fewer total fragility fractures than patients receiving usual care. Over the study horizon, the H-FLS led to only a $54 incremental cost/patient with a modest gain of 8 QALYs/1000 patients. The incremental cost-effectiveness ratio (ICER) of $6750/QALY gained was less than the $27,000 cost-effectiveness threshold. Eliminating the 9-month follow-up resulted in incremental savings of $218/patient while also reducing 6-month follow-ups increased cost-savings to $378/patient. Probabilistic sensitivity analyses suggested that the H-FLS would either be cost-saving (60%) or cost-effective (40%). Conclusion A H-FLS implemented into standard practice significantly improved anti-absorptive medication use; a cohort simulation cost-effectiveness analysis (CEA) suggested that the H-FLS was cost-effective with potential to become cost-savings. Keywords Hip fracture liaison service . Osteoporosis . Cost-effectiveness . Implementation science . Fragility fracture network
S. R. Majumdar is deceased. This paper is dedicated to his memory. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11657-020-00781-w) contains supp
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