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Cost-effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: a population based study

Cost-effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: a population based study
Cost-effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: a population based study
Fracture liaison services are recommended as a model of best practice for organising patient care and secondary fracture prevention for hip fracture patients, although variation exists in how such services are structured. There is considerable uncertainty as to which model is most cost-effective and should therefore be mandated. This study evaluated the cost-effectiveness of orthogeriatric (OG) and nurse-led fracture liaison service (FLS) models of post-hip fracture care compared to usual care. Analyses were conducted from a healthcare and personal social services payer perspective, using a Markov model to estimate the lifetime impact of the models of care. The base-case population consisted of men and women aged 83 years with a hip fracture. The risk and costs of hip and non-hip fractures were derived from large primary and hospital care datasets in the UK. Utilities were informed by a meta-regression of 32 studies. In the base-case analysis, the orthogeriatric-led service was the most effective and cost-effective model of care at a threshold of £30,000 per quality-adjusted life years gained (QALY). For women age 83 years, the OG-led service was the most cost-effective at £22,709/QALY. If only healthcare costs are considered, OG-led service was cost-effective at £12,860/QALY and £14,525/QALY for women and men aged 83 years, respectively. Irrespective of how patients were stratified in terms of their age, sex, and Charlson co-morbidity score at index hip fracture, our results suggest that introducing an orthogeriatrician-led or a nurse-led FLS is cost-effective when compared to usual care. Although, considerable uncertainty remains concerning which of the models of care should be preferred, introducing an orthogeriatrician-led service seems to be the most cost-effective service to pursue.
0884-0431
1-27
Leal, J.
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Gray, A.M.
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Hawley, S.
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Priero-Alhambra, D.
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Delmestri, A.
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Arden, N.K.
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Cooper, C.
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Javaid, M.K.
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Judge, A.
c6a83964-1d7c-4aa8-b2bf-9c264d1e487d
Leal, J.
dc621c35-59cb-49d2-ab7a-0ada841eb3b7
Gray, A.M.
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Hawley, S.
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Priero-Alhambra, D.
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Delmestri, A.
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Arden, N.K.
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Cooper, C.
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Javaid, M.K.
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Judge, A.
c6a83964-1d7c-4aa8-b2bf-9c264d1e487d

Leal, J., Gray, A.M., Hawley, S., Priero-Alhambra, D., Delmestri, A., Arden, N.K., Cooper, C., Javaid, M.K. and Judge, A. (2016) Cost-effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: a population based study. Journal of Bone and Mineral Research, 1-27. (doi:10.1002/jbmr.2995). (PMID:27632945)

Record type: Article

Abstract

Fracture liaison services are recommended as a model of best practice for organising patient care and secondary fracture prevention for hip fracture patients, although variation exists in how such services are structured. There is considerable uncertainty as to which model is most cost-effective and should therefore be mandated. This study evaluated the cost-effectiveness of orthogeriatric (OG) and nurse-led fracture liaison service (FLS) models of post-hip fracture care compared to usual care. Analyses were conducted from a healthcare and personal social services payer perspective, using a Markov model to estimate the lifetime impact of the models of care. The base-case population consisted of men and women aged 83 years with a hip fracture. The risk and costs of hip and non-hip fractures were derived from large primary and hospital care datasets in the UK. Utilities were informed by a meta-regression of 32 studies. In the base-case analysis, the orthogeriatric-led service was the most effective and cost-effective model of care at a threshold of £30,000 per quality-adjusted life years gained (QALY). For women age 83 years, the OG-led service was the most cost-effective at £22,709/QALY. If only healthcare costs are considered, OG-led service was cost-effective at £12,860/QALY and £14,525/QALY for women and men aged 83 years, respectively. Irrespective of how patients were stratified in terms of their age, sex, and Charlson co-morbidity score at index hip fracture, our results suggest that introducing an orthogeriatrician-led or a nurse-led FLS is cost-effective when compared to usual care. Although, considerable uncertainty remains concerning which of the models of care should be preferred, introducing an orthogeriatrician-led service seems to be the most cost-effective service to pursue.

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Accepted/In Press date: 14 September 2016
e-pub ahead of print date: 16 September 2016
Organisations: Faculty of Medicine

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Local EPrints ID: 400598
URI: http://eprints.soton.ac.uk/id/eprint/400598
ISSN: 0884-0431
PURE UUID: 4d9112a1-f4d7-48a5-8952-db9b31488ce6
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 20 Sep 2016 08:50
Last modified: 07 Oct 2020 05:14

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Contributors

Author: J. Leal
Author: A.M. Gray
Author: S. Hawley
Author: D. Priero-Alhambra
Author: A. Delmestri
Author: N.K. Arden
Author: C. Cooper ORCID iD
Author: M.K. Javaid
Author: A. Judge

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