Naranjo Antonio, Prieto-Alhambra Daniel, Sánchez-Martín Julián, Pérez-Mitru Alejandro, Brosa Max
Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35011, Spain.
NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
Clinicoecon Outcomes Res. 2022 Apr 22;14:249-264. doi: 10.2147/CEOR.S350790. eCollection 2022.
To assess the cost-effectiveness of a Fracture Liaison Service (FLS) compared with standard care for the secondary prevention of fragility fractures in Spain.
Patients with osteoporosis and an initial fragility fracture who were candidates to initiate osteoporosis treatment (mean age 65 years, 90.7% female) were included in the model. Disease progression was simulated with a Markov model through seven health states (with and without osteoporosis treatment, subsequent hip, vertebral, forearm and humerus fracture, and death). A time horizon of 10 years and a 6-month duration per cycle was set. Clinical, economic, and quality of life parameters were estimated from the literature and Spanish clinical practice. Resource use and treatment patterns were validated by an expert panel. The Spanish National Health System (SNS) perspective was adopted, taking direct costs (€; 2020) into account. Effectiveness was measured in life-years gained (LYG) and quality-adjusted life years gained (QALYs). A discount rate of 3% was applied to costs and outcomes. The uncertainty of the parameters was assessed using deterministic, scenario and probabilistic sensitivity analyses (1000 iterations).
Setting up a FLS for the secondary prevention of fragility fractures in Spain would provide better osteoporosis treatment initiation and persistence. This would reduce subsequent fragility fractures, disutilities and deaths. FLS would have greater clinical benefits (0.008 and 0.082 LYG and QALY gained per patient, respectively) and higher costs (€563.69 per patient) compared with standard care, leading to an incremental cost-utility ratio of €6855.23 per QALY gained over the 10 years horizon. The sensitivity analyses showed limited dispersion of the base case results, corroborating their robustness.
From the SNS perspective and considering Spanish willingness-to-pay thresholds, the introduction of FLS for the secondary prevention of fragility fractures would be a cost-effective strategy.
评估骨折联络服务（FLS）与西班牙脆性骨折二级预防标准护理相比的成本效益。
模型纳入了患有骨质疏松症且首次发生脆性骨折并符合启动骨质疏松症治疗条件的患者（平均年龄65岁，女性占90.7%）。通过马尔可夫模型模拟疾病进展，涵盖七个健康状态（接受或未接受骨质疏松症治疗、随后发生髋部、椎体、前臂和肱骨骨折以及死亡）。设定时间范围为10年，每个周期时长为6个月。临床、经济和生活质量参数依据文献及西班牙临床实践进行估算。资源使用和治疗模式经专家小组验证。采用西班牙国家卫生系统（SNS）视角，考虑直接成本（欧元；2020年）。有效性通过获得的生命年数（LYG）和获得的质量调整生命年数（QALY）来衡量。对成本和结果应用3%的贴现率。使用确定性、情景和概率敏感性分析（1000次迭代）评估参数的不确定性。
在西班牙建立用于脆性骨折二级预防的FLS将使骨质疏松症治疗的启动和持续情况更佳。这将减少后续脆性骨折、功能障碍和死亡。与标准护理相比，FLS将具有更大的临床益处（每位患者分别获得0.008和0.082个LYG和QALY）以及更高的成本（每位患者563.69欧元），在10年时间范围内每获得一个QALY的增量成本效用比为6855.23欧元。敏感性分析表明基本案例结果的离散度有限，证实了其稳健性。
从SNS视角并考虑西班牙的支付意愿阈值，引入用于脆性骨折二级预防的FLS将是一项具有成本效益的策略。
