Olmo-Montes Francisco Jesús, Caeiro-Rey José Ramón, Peris Pilar, Pérez Del Río Verónica, Etxebarria-Foronda Íñigo, Cancio-Trujillo José Manuel, Pareja Teresa, Jódar Esteban, Naranjo Antonio, Moro-Álvarez María Jesús, García-Goñi Manuel, Vergés Josep, Maratia Stefano, Campos Tapias Ignasi, Prades Miriam, Aceituno Susana
Internal Medicine Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain.
Traumatology Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
Clinicoecon Outcomes Res. 2024 Dec 24;16:889-901. doi: 10.2147/CEOR.S480674. eCollection 2024.
This study evaluates the Social Return on Investment (SROI) of implementing measures to prevent fragility fractures in postmenopausal women with osteoporosis (OP) in Spain.
A group of 13 stakeholders identified necessary actions for improving refracture prevention and assessed the investment required from the Spanish National Health System (SNHS), considering direct, indirect, and intangible costs over a one-year period. Unitary costs were sourced from scientific literature and official data, and intangible costs were estimated through surveys on women's willingness to pay for better health-related quality of life. The SROI ratio was calculated from both a social perspective (including all returns) and the SNHS perspective (including only direct and intangible costs). A sensitivity analysis evaluated the returns in worst- and best-case scenarios over three years.
Stakeholders agreed on four main actions: 1) establishing fracture liaison services; 2) harmonizing clinical practice guidelines and provide training for healthcare professionals (HCPs); 3) promoting HCPs' adherence to fracture registries and 4) raising awareness of OP and fragility fractures. From the social perspective, implementing these actions would cost the SNHS €4,375,663 but yield a social return of €96,939,931 in the first year, resulting in a SROI ratio of €22.15 per euro invested (€28.69, 23.14, 24.29, and 10.70 for the four actions, respectively). From the SNHS perspective, the return would be €36,453,509 (€21,523,444 tangible), with a SROI of €8.33 (€4.92 tangible) and for the four actions: €9.99, 9.39, 8.45, and 3.79, respectively (€5.89, 5.54, 4.96 and 2.27 tangible). The investment would be lower than the return for all actions (3.49%, 4.32%, 4.12% and 9.34% of social perspective return, respectively) and scenarios.
According to our SROI method, implementing different actions to improve secondary fracture prevention would achieve a considerable social benefit, which, in terms of direct, indirect, and intangible costs, would far outweigh the investment.
本研究评估在西班牙对骨质疏松症（OP）绝经后女性实施预防脆性骨折措施的社会投资回报率（SROI）。
一组13名利益相关者确定了改善骨折预防所需的必要行动，并评估了西班牙国家卫生系统（SNHS）所需的投资，考虑了一年期间的直接、间接和无形成本。单位成本来自科学文献和官方数据，无形成本通过对女性为改善与健康相关的生活质量的支付意愿进行调查来估计。SROI比率从社会角度（包括所有回报）和SNHS角度（仅包括直接和无形成本）进行计算。敏感性分析评估了三年中最坏和最好情况下的回报。
利益相关者就四项主要行动达成一致：1）建立骨折联络服务；2）统一临床实践指南并为医疗保健专业人员（HCPs）提供培训；3）促进HCPs对骨折登记处的遵守；4）提高对OP和脆性骨折的认识。从社会角度来看，实施这些行动将使SNHS花费4375663欧元，但在第一年产生96939931欧元的社会回报，投资回报率为每投资1欧元回报22.15欧元（四项行动分别为28.69欧元、23.14欧元、24.29欧元和10.70欧元）。从SNHS角度来看，回报将为36453509欧元（21523444欧元为有形回报），SROI为8.33欧元（4.92欧元为有形回报），四项行动分别为9.99欧元、9.39欧元、8.45欧元和3.79欧元（有形回报分别为5.89欧元、5.54欧元、4.96欧元和2.27欧元）。所有行动的投资均低于回报（分别占社会角度回报的3.49%、4.32%、4.12%和9.34%）以及各种情况。
根据我们的SROI方法，实施不同行动以改善继发性骨折预防将实现可观的社会效益，就直接、间接和无形成本而言，这将远远超过投资。
