Cost-Utility Analysis of the Ontario Fracture Screening and Prevention Program. (7th July 2021)

• Record Type: Journal Article
• Authors: Saunders, Hailey; Sujic, Rebeka; Bogoch, Earl R.; Jain, Ravi; Jinah, Ashna; Elliot-Gibson, Victoria; Mendlowitz, Andrew B.; Linton, Denise; Inrig, Taucha; Isaranuwatchai, Wanrudee; Sale, Joanna E.M.
• Is Part Of: Journal of bone and joint surgery. Volume 103:Number 13(2021)
• Page Start: 1175
• Page End: 1183
• Publication Date: 2021-07-07
• Subjects: Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedics -- Periodicals; Orthopedics; General Surgery; Bone Diseases; Joint Diseases; Bones -- Surgery; Joints -- Surgery; Orthopedics; Bot (anatomie); Gewrichten; Chirurgie (geneeskunde); Periodicals; Electronic journals; Periodicals; 617.47005
• DOI: 10.2106/JBJS.20.00795
• Languages: English
• ISSNs: 0021-9355

Abstract

Abstract : Update: This article was updated on March 15, 2022, because of a previous error. On pages 1175, 1179, and 1180, in the Abstract, Results, and Figure 3 legend, the incremental cost that had read a negative "$274" now reads a negative "$277"; this change did not affect the interpretation of the results. An erratum has been published: J Bone Joint Surg Am. 2022 Apr 20;104(8):e34. Background: The Fracture Screening and Prevention Program (FSPP), a fracture liaison service (FLS), was implemented in the province of Ontario, Canada, in 2007 to prevent recurrent fragility fractures and to improve post-fracture care. The objective of this analysis was to determine the cost-effectiveness of the current model of the FSPP compared with usual care (no program) from the perspective of the universal public health-care payer (Ontario Ministry of Health and Long-Term Care [MOHLTC]), over the lifetime of older adults who presented with a fragility fracture of the proximal part of the femur, the proximal part of the humerus, or the distal part of the radius and were not taking medications to prevent or slow bone loss and reduce the risk of fracture (bone active medications). Methods: We developed a state-transition (Markov) model to conduct a cost-effectiveness analysis of the FSPP in comparison with usual care. The model simulated a cohort of patients with a fragility fracture starting at 71 years of age. Model parameters were obtained from published literature and from the FSPP. Quality-adjusted life-years (QALYs) and costs in 2018 Canadian dollars were predicted over a lifetime horizon using a 1.5% annual discount rate. Health outcomes included subsequent proximal femoral, vertebral, proximal humeral, and distal radial fractures. Scenario and subgroup analyses were reported. Results: The FSPP had lower expected costs ($277 less) and higher expected effectiveness (by 0.018 QALY) than usual care over the lifetime horizon. Ninety-four percent of the 10, 000 Monte Carlo simulated incremental cost-effectiveness ratios (ICERs) demonstrated lower costs and higher effectiveness of the FSPP. Conclusions: The FSPP appears to be cost-effective compared with usual care over a lifetime for patients with fragility fracture. This information may help to quantify the value of the FSPP and to assist policy-makers in deciding whether to expand the FSPP to additional hospitals or to initiate similar programs where none exist. Level of Evidence: Economic and Decision Analysis Level II . See Instructions for Authors for a complete description of levels of evidence.