University of Birmingham, Birmingham, UK.
Osteoporos Int. 2012 Jan;23(1):97-107. doi: 10.1007/s00198-011-1802-z. Epub 2011 Sep 28.
We evaluated the cost-effectiveness of a fracture liaison service prospectively designed to have a parallel control group treated by standard care. The clinical effectiveness of this service was associated with an incremental cost-effectiveness ratio versus standard care of Australian dollars (AUD) 17,291 per quality-adjusted life year (QALY) gained.
Osteoporotic fractures are a major burden for national health services. The risk of re-fracture following an osteoporotic fracture is particularly high. In a study unique in prospectively having a control group treated by standard care, we recently demonstrated that a Minimal Trauma Fracture Liaison (MTFL) service significantly reduces the risk of re-fracture by 80%. Since the service involves greater use of resources, we have now evaluated whether it is cost-effective.
A Markov model was developed that incorporated fracture probabilities and resource utilization data (expressed in AUD) obtained directly from the 4-year MTFL service clinical study. Resource utilization, local cost and mortality data and fracture-related health utility data were used to calculate QALYs with the MTFL service and standard care. Main outcome measures were: additional costs of the MTFL service over standard care, the financial savings achieved through reduced fractures and changes in QALYs associated with reduced fractures calculated over a 10-year simulation period. Costs and QALYs were discounted at 5% annually. Sensitivity analyses quantified the effects of different assumptions of effectiveness and resource utilization associated with the MTFL service.
The MTFL service improved QALYs by 0.089 years and led to increased costs of AUD 1,486 per patient versus standard care over the 10-year simulation period. The incremental cost-effectiveness ratio versus standard care was AUD 17,291 per QALY gained. Results were robust under all plausible assumptions.
The MTFL service is a cost-effective intervention to reduce recurrent osteoporotic fractures.
我们前瞻性地评估了骨折联络服务的成本效益，该服务旨在设立一个平行的对照组，采用标准护理。该服务的临床效果与标准护理相比，每获得一个质量调整生命年（QALY）的增量成本效益比为 17291 澳元（AUD）。
骨质疏松性骨折对国家卫生服务系统是一个重大负担。骨质疏松性骨折后再次骨折的风险特别高。在一项前瞻性研究中，我们有一个独特的对照组，采用标准护理，我们最近证明，最小创伤性骨折联络（MTFL）服务可显著降低 80%的再次骨折风险。由于该服务涉及更多的资源利用，我们现在已经评估了它是否具有成本效益。
我们开发了一个马尔可夫模型，该模型纳入了骨折概率和资源利用数据（以澳元表示），这些数据直接来自为期 4 年的 MTFL 服务临床研究。资源利用、当地成本和死亡率数据以及与骨折相关的健康效用数据被用于计算 MTFL 服务和标准护理的 QALYs。主要观察指标为：MTFL 服务相对于标准护理的额外成本、通过减少骨折实现的财务节约以及通过减少骨折导致的 QALY 变化，这些变化是在 10 年模拟期间计算得出的。成本和 QALYs 每年贴现 5%。敏感性分析量化了与 MTFL 服务相关的有效性和资源利用的不同假设的影响。
MTFL 服务使 QALYs 提高了 0.089 年，与标准护理相比，在 10 年模拟期间每位患者的成本增加了 1486 澳元。相对于标准护理，增量成本效益比为每获得一个 QALY 增加 17291 澳元。在所有合理的假设下，结果都是稳健的。
MTFL 服务是一种降低复发性骨质疏松性骨折的成本效益干预措施。
