We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture.
- Authors
Majumdar, S. R.; Lier, D. A.; Rowe, B. H.; Russell, A. S.; McAlister, F. A.; Maksymowych, W. P.; Hanley, D. A.; Morrish, D. W.; Johnson, J. A.
- Abstract
Summary: In a randomized trial, a multifaceted intervention tripled rates of osteoporosis treatment in older patients with wrist fracture. An economic analysis of the trial now demonstrates that the intervention tested 'dominates' usual care: over a lifetime horizon, it reduces fracture, increases quality-adjusted life years, and saves the healthcare system money. Introduction: In a randomized trial ( N = 272), we reported a multifaceted quality improvement intervention directed at older patients and their physicians could triple rates of osteoporosis treatment within 6 months of a wrist fracture when compared with usual care (22% vs 7%). Alongside the trial, we conducted an economic evaluation. Methods: Using 1-year outcome data from our trial and micro-costing time-motion studies, we constructed a Markov decision-analytic model to determine cost-effectiveness of the intervention compared with usual care over the patients' remaining lifetime. We took the perspective of third-party healthcare payers. In the base case, costs and benefits were discounted at 3% and expressed in 2006 Canadian dollars. One-way deterministic and probabilistic sensitivity analyses were conducted. Results: Median age of patients was 60 years, 77% were women, and 72% had low bone mineral density (BMD). The intervention cost $12 per patient. Compared with usual care, the intervention strategy was dominant: for every 100 patients receiving the intervention, three fractures (one hip fracture) would be prevented, 1.1 quality-adjusted life year gained, and $26,800 saved by the healthcare system over their remaining lifetime. The intervention dominated usual care across numerous one-way sensitivity analyses: with respect to cost, the most influential parameter was drug price; in terms of effectiveness, the most influential parameter was rate of BMD testing. The intervention was cost saving in 80% of probabilistic model simulations. Conclusions: For outpatients with wrist fractures, our multifaceted osteoporosis intervention was cost-effective. Healthcare systems implementing similar interventions should expect to save money, reduce fractures, and gain quality-adjusted life expectancy.
- Subjects
TREATMENT of fractures; OSTEOPOROSIS treatment; COMPUTER software; CONFIDENCE intervals; COST effectiveness; EPIDEMIOLOGY; MEDICAL quality control; PREVENTIVE health services; RESEARCH funding; WRIST; DATA analysis; BONE density; RANDOMIZED controlled trials
- Publication
Osteoporosis International, 2011, Vol 22, Issue 6, p1799
- ISSN
0937-941X
- Publication type
Article
- DOI
10.1007/s00198-010-1412-1