Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
J Bone Joint Surg Am. 2021 Jul 7;103(13):1175-1183. doi: 10.2106/JBJS.20.00795.
The Fracture Screening and Prevention Program (FSPP), a fracture liaison service (FLS), was implemented in the province of Ontario, Canada, in 2007 to prevent recurrent fragility fractures and to improve post-fracture care. The objective of this analysis was to determine the cost-effectiveness of the current model of the FSPP compared with usual care (no program) from the perspective of the universal public health-care payer (Ontario Ministry of Health and Long-Term Care [MOHLTC]), over the lifetime of older adults who presented with a fragility fracture of the proximal part of the femur, the proximal part of the humerus, or the distal part of the radius and were not taking medications to prevent or slow bone loss and reduce the risk of fracture (bone active medications).
We developed a state-transition (Markov) model to conduct a cost-effectiveness analysis of the FSPP in comparison with usual care. The model simulated a cohort of patients with a fragility fracture starting at 71 years of age. Model parameters were obtained from published literature and from the FSPP. Quality-adjusted life-years (QALYs) and costs in 2018 Canadian dollars were predicted over a lifetime horizon using a 1.5% annual discount rate. Health outcomes included subsequent proximal femoral, vertebral, proximal humeral, and distal radial fractures. Scenario and subgroup analyses were reported.
The FSPP had lower expected costs ($277 less) and higher expected effectiveness (by 0.018 QALY) than usual care over the lifetime horizon. Ninety-four percent of the 10,000 Monte Carlo simulated incremental cost-effectiveness ratios (ICERs) demonstrated lower costs and higher effectiveness of the FSPP.
The FSPP appears to be cost-effective compared with usual care over a lifetime for patients with fragility fracture. This information may help to quantify the value of the FSPP and to assist policy-makers in deciding whether to expand the FSPP to additional hospitals or to initiate similar programs where none exist.
Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.
骨折筛查和预防计划（FSPP）是一种骨折联络服务（FLS），于 2007 年在加拿大安大略省实施，旨在预防复发性脆性骨折并改善骨折后的护理。本分析的目的是从全民医疗保健支付者（安大略省卫生部和长期护理部[MOHLTC]）的角度确定当前 FSPP 模式与常规护理（无计划）相比的成本效益，在出现股骨近端、肱骨近端或桡骨远端脆性骨折且未服用预防或减缓骨质流失和降低骨折风险的药物（骨质活跃药物）的老年人的一生中。
我们开发了一个状态转换（Markov）模型，以对 FSPP 与常规护理进行成本效益分析。该模型模拟了一组 71 岁开始发生脆性骨折的患者队列。模型参数来自已发表的文献和 FSPP。使用 1.5%的年贴现率，在终身范围内预测 2018 年加拿大元的质量调整生命年（QALY）和成本。健康结果包括随后的股骨近端、椎体、肱骨近端和桡骨远端骨折。报告了情景和亚组分析。
在终身范围内，FSPP 的预期成本（低 277 美元）和预期效果（高 0.018 QALY）均低于常规护理。在 10000 次蒙特卡罗模拟增量成本效益比（ICER）中，有 94%的 FSPP 表现出较低的成本和较高的效果。
与常规护理相比，FSPP 在脆性骨折患者的一生中具有成本效益。这些信息可能有助于量化 FSPP 的价值，并帮助决策者决定是否将 FSPP 扩展到其他医院，或在没有此类计划的情况下启动类似的计划。
经济和决策分析水平 II。有关证据水平的完整描述，请参阅作者说明。
