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Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision

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Abstract

Summary

The cost-effectiveness of Fracture Liaison Services (FLSs) for prevention of secondary fracture in osteoporosis patients in the United Kingdom (UK), and the cost associated with their widespread adoption, were evaluated. An estimated 18 fractures were prevented and £21,000 saved per 1,000 patients. Setup across the UK would cost an estimated £9.7 million.

Introduction

Only 11% to 28% of patients with a fragility fracture receive osteoporosis treatment in the UK. FLSs provide an efficient means to identify patients and are endorsed by the Department of Health but have not been widely adopted. The objective of this study was to evaluate the cost-effectiveness of FLSs in the UK and the cost associated with their widespread adoption.

Methods

A cost-effectiveness and budget-impact model was developed, utilising detailed audit data collected by the West Glasgow FLS.

Results

For a hypothetical cohort of 1,000 fragility-fracture patients (740 requiring treatment), 686 received treatment in the FLS compared with 193 in usual care. Assessments and osteoporosis treatments cost an additional £83,598 and £206,544, respectively, in the FLS; 18 fractures (including 11 hip fractures) were prevented, giving an overall saving of £21,000. Setup costs for widespread adoption of FLSs across the UK were estimated at £9.7 million.

Conclusions

FLSs are cost-effective for the prevention of further fractures in fragility-fracture patients. The cost of widespread adoption of FLS across the UK is small in comparison with other service provision and would be expected to result in important benefits in fractures avoided and reduced hospital bed occupancy.

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Notes

  1. In an audit of the Glasgow Direct Access DXA Service, GPs instituted the recommended treatment in 96% of cases and another treatment in most remaining cases. In a survey of patients recommended treatment by the Glasgow FLS 6 to 12 months after initiation of therapy, of the 66% of those who responded, 86% to 88% indicated they were taking the recommended treatment.

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Acknowledgements

Funding for this work was provided by Novartis Pharmaceuticals UK Ltd. The authors would like to acknowledge Dr. Christopher Andrews of Novartis Pharmaceuticals UK Ltd for statistical analysis of the West Glasgow refracture data.

Conflicts of interest

AR McLellan has received honoraria (Speaker’s Fees) from Novartis & has participated in advisory boards supported by Novartis. D Roberts and F Adekunle are employees of Novartis Pharmaceuticals UK Ltd and hold shares in the company. Novartis Pharmaceuticals UK Ltd provided funding to RTI Health Solutions to perform the research reported in the manuscript. Novartis Pharmaceuticals UK Ltd is the manufacturer of zoledronic acid 5 mg (also known as zoledronate), one of the osteoporosis treatments mentioned in the manuscript. Novartis Pharmaceuticals UK Ltd provided statistical support for the analysis of anonymised patient level data from the West Glasgow FLS that was provided by Dr AR McLellan.

Author information

Authors and Affiliations

  1. Gardiner Institute, Western Infirmary, Glasgow, G11 6NT, UK

    A. R. McLellan

  2. RTI-Health Solutions, Manchester University Science Park, Williams House, Lloyd Street North, Manchester, M15 6SE, UK

    S. E. Wolowacz, E. A. Zimovetz, S. M. Beard, S. Lock & L. McCrink

  3. Novartis Pharmaceuticals UK Ltd, Frimley Business Park, Frimley, Camberley, Surrey, GU16 7SR, UK

    F. Adekunle & D. Roberts

Authors
  1. A. R. McLellan
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  2. S. E. Wolowacz
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  3. E. A. Zimovetz
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  4. S. M. Beard
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  5. S. Lock
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  6. L. McCrink
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  7. F. Adekunle
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  8. D. Roberts
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Corresponding author

Correspondence to S. E. Wolowacz.

Additional information

A related editorial can be found at doi:10.1007/s00198-011-1643-9; other related articles at doi:10.1007/s00198-010-1544-y, doi:10.1007/s00198-011-1638-6, and doi:10.1007/s00198-011-1642-x.

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McLellan, A.R., Wolowacz, S.E., Zimovetz, E.A. et al. Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos Int 22, 2083–2098 (2011). https://doi.org/10.1007/s00198-011-1534-0

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