College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoe-Ro, Yeonsu-Gu, Incheon, 21936, Republic of Korea.
Department of Orthopedic Surgery, College of Medicine, Seoul National University Bundang Hospital, Seoul National University, Seongnam, Republic of Korea.
Calcif Tissue Int. 2022 Oct;111(4):380-390. doi: 10.1007/s00223-022-01000-z. Epub 2022 Jul 5.
An alarm service in an order communication system (OCS) was found to be effective at increasing the rate of dual-energy X-ray absorptiometry (DXA) testing and treatment in South Korea, but its cost-effectiveness remains unknown. We used a Markov model to determine the cost-effectiveness of the alarm service in the OCS compared to no alarm service for the post-fracture management of subjects aged 50 years and older with fragility fractures. DXA testing and treatment data were collected from a prospective cohort study. The prevalence of osteoporotic fractures, the subsequent risk of hip fracture, and healthcare costs were obtained using Korea National Health Insurance claims data. The lifetime cost and quality-adjusted life-years (QALYs) gained were estimated from a healthcare perspective. A probabilistic sensitivity analysis was performed to examine the uncertainty of the results. The alarm service increased treatment by 125 per 1000 patients and prevented 3 hip fractures per 1000 patients. The alarm service cost an additional 249,393 KRW and resulted in an increase of 0.008 QALYs per patient compared to no alarm service. The incremental cost-effectiveness ratio was 31,174,125 KRW (26,843 USD) per QALY gained. The alarm service was cost-effective than no alarm service if the willingness to pay setting as 1GDP per capita (29,288 USD) per QALY gained. This study shows that less-intensive fracture liaison services, such as an alarm service, are cost-effective for patients aged 50 years and older with osteoporotic fractures in Korea. An intensive model, including enhanced identification and education, could further prevent the risk of refracture and improve cost-effectiveness.
在订单通信系统 (OCS) 中设置警报服务被发现可以有效地提高韩国双能 X 射线吸收法 (DXA) 检测和治疗的比率，但它的成本效益仍然未知。我们使用马尔可夫模型来确定与没有警报服务相比，OCS 中的警报服务在治疗 50 岁及以上脆性骨折患者方面的成本效益。DXA 检测和治疗数据来自一项前瞻性队列研究。骨质疏松性骨折的患病率、随后髋部骨折的风险以及医疗保健成本使用韩国国家健康保险索赔数据获得。从医疗保健角度估计了终生成本和质量调整生命年 (QALY)。进行概率敏感性分析以检查结果的不确定性。与没有警报服务相比，警报服务增加了每 1000 名患者 125 次治疗，并预防了每 1000 名患者 3 次髋部骨折。警报服务增加了 249,393 韩元的额外成本，并导致每位患者的 QALY 增加了 0.008。增量成本效益比为每获得一个 QALY 增加 31,174,125 韩元（26,843 美元）。如果按照每获得一个 QALY 1 个人均 GDP（29,288 美元）的支付意愿设定，那么警报服务比没有警报服务更具成本效益。这项研究表明，对于韩国 50 岁及以上患有骨质疏松性骨折的患者来说，像警报服务这样不太密集的骨折联络服务具有成本效益。包括强化识别和教育在内的密集模型可以进一步降低再骨折风险并提高成本效益。
