Department of Rehabilitation & Aged Care, Sir Charles Gairdner and Osborne Park Hospital Group, Nedlands, Western Australia, Australia.
School of Medicine & Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia.
Australas J Ageing. 2022 Sep;41(3):e266-e275. doi: 10.1111/ajag.13107. Epub 2022 Jul 10.
To assess the benefits of the Emergency Department Information System (EDIS)-linked fracture liaison service (FLS).
Patients identified through EDIS were invited to attend an FLS at the intervention hospital, the Sir Charles Gairdner Hospital (SCGS-FLS). The intervention group was compared to usual care. Retrospective control (RC) at this hospital determined historical fracture risk (SCGH-RC). Prospective control (PC) was from a comparator, Fremantle Hospital (FH-PC). The main outcome measures were cost-effectiveness from a health system perspective and quality of life by EuroQOL (EQ-5D). Bottom-up cost of medical care, against the cost of managing recurrent fracture (weighted basket), was determined from the literature and 2013/14 Australian Refined Diagnosis Related Groups (AR-DRG) prices. Mean incremental cost-effectiveness ratios were simulated from 5000 bootstrap iterations. Cost-effectiveness acceptability curves were generated.
The SCGH-FLS program reduced absolute re-fracture rates versus control cohorts (9.2-10.2%), producing an estimated cost saving of AUD$750,168-AUD$810,400 per 1000 patient-years in the first year. Between-groups QALYs differed with worse outcomes in both control groups (p < 0.001). The SCGH-FLS compared with SCGH-RC and FH-PC had a mean incremental cost of $8721 (95% CI -$1218, $35,044) and $8974 (95% CI -$26,701, $69,929), respectively, per 1% reduction in 12-month recurrent fracture risk. The SCGH-FLS compared with SCGH-RC and FH-PC had a mean incremental cost of $292 (95% CI -$3588, $3380) and -$261 (95% CI -$1521, $471) per EQ-5D QALY gained at 12 months respectively. With societal willingness to pay of $16,000, recurrent fracture is reduced by 1% in >80% of patients.
This simple and easy model of identification and intervention demonstrated efficacy in reducing rates of recurrent fracture and was cost-effective and potentially cost saving.
评估急诊信息系统（EDIS）链接骨折联络服务（FLS）的益处。
通过 EDIS 识别的患者被邀请参加干预医院，即查尔斯·盖尔德纳爵士医院（SCGS-FLS）的 FLS。干预组与常规护理进行比较。该医院的回顾性对照（RC）确定了历史骨折风险（SCGH-RC）。前瞻性对照（PC）来自比较者弗里曼特尔医院（FH-PC）。主要观察指标是从健康系统角度评估成本效益和生活质量（EQ-5D）。根据文献和 2013/14 年澳大利亚精炼诊断相关组（AR-DRG）价格，确定医疗保健的自下而上成本，以管理复发性骨折的成本（加权篮子）。从 5000 次引导迭代中模拟平均增量成本效益比。生成成本效益可接受性曲线。
与对照组相比，SCGH-FLS 计划降低了绝对再骨折率（9.2-10.2%），在第一年每 1000 名患者中估计可节省 750168 澳元至 810400 澳元的成本。两组间的 QALYs 不同，两组的对照组结果均较差（p<0.001）。与 SCGH-RC 和 FH-PC 相比，SCGH-FLS 的平均增量成本分别为 8721 澳元（95%CI-1218 澳元，35044 澳元）和 8974 澳元（95%CI-26701 澳元，69929 澳元），每降低 12 个月内复发性骨折风险 1%。与 SCGH-RC 和 FH-PC 相比，SCGH-FLS 在 12 个月时分别获得了 292 澳元（95%CI-3588 澳元，3380 澳元）和-261 澳元（95%CI-1521 澳元，471 澳元）的 EQ-5D QALY。在社会愿意支付 16000 澳元的情况下，超过 80%的患者的复发性骨折率降低了 1%。
这种简单易用的识别和干预模式在降低复发性骨折率方面显示出疗效，并且具有成本效益，可能具有成本节约效果。
