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Expected benefits and budget impact from a microsimulation model support the prioritisation and implementation of Fracture Liaison Services

Expected benefits and budget impact from a microsimulation model support the prioritisation and implementation of Fracture Liaison Services
Expected benefits and budget impact from a microsimulation model support the prioritisation and implementation of Fracture Liaison Services

Osteoporotic-related fractures cause significant patient disability, leading to a growing burden on health care systems. Effective secondary fracture prevention can be delivered by fracture liaison services (FLSs), but these are not available in most countries. A major barrier is insufficient policy prioritization, helped by the lack of economic assessments using national data and providing estimates of patient outcomes alongside health care resource use and cost impacts. The aim of this study was to develop an economic model to estimate the benefits and budget impact of FLSs and support their wider international implementation. Five interconnected stages were undertaken: establishment of a generic patient pathway; model design; identification of model inputs; internal validation and output generation; and scenario analyses. A generic patient pathway including FLS activities was built to underpin the economic model. A state-based microsimulation model was developed to estimate the impact of FLSs compared with current practice for men and women aged 50 years or older with a fragility fracture. The model provides estimates for health outcomes (subsequent fractures avoided and quality-adjusted life years [QALYs]), resource use, and health and social care costs, including those necessary for FLSs to operate, over 5 years. The model was run for an exemplar country the size of the United Kingdom. FLSs were estimated to lead to a reduction of 13,149 subsequent fractures and a gain of 11,709 QALYs. Hospital-bed days would be reduced by 120,989 and surgeries by 6455, while 3556 person-years of institutional social care would be avoided. Expected costs per QALY gained placed FLSs as highly cost-effective at £8258 per QALY gained over the first 5 years. Ten different scenarios were modeled using different configurations of FLSs. Further work to develop country-specific models is underway to delivery crucial national level data to inform the prioritization of FLSs by policy makers. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

ANABOLICS, FRACTURE PREVENTION, HEALTH ECONOMICS, HEALTH SERVICES RESEARCH, OSTEOPOROSIS
0884-0431
499-511
Pinedo-Villanueva, Rafael
7375e99b-3bac-4210-841e-ec4724df9131
Burn, Edward
0277b51a-3aa1-40f2-81fb-96c506587db6
Maronga, Christopher
3c7fb861-1cbd-491a-b195-c5cad8f1a98e
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Kassim Javaid, M
12781b29-34fa-4158-837b-daf452b8d4ed
Pinedo-Villanueva, Rafael
7375e99b-3bac-4210-841e-ec4724df9131
Burn, Edward
0277b51a-3aa1-40f2-81fb-96c506587db6
Maronga, Christopher
3c7fb861-1cbd-491a-b195-c5cad8f1a98e
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Kassim Javaid, M
12781b29-34fa-4158-837b-daf452b8d4ed

Pinedo-Villanueva, Rafael, Burn, Edward, Maronga, Christopher, Cooper, Cyrus and Kassim Javaid, M (2023) Expected benefits and budget impact from a microsimulation model support the prioritisation and implementation of Fracture Liaison Services. Journal of Bone and Mineral Research, 38 (4), 499-511. (doi:10.1002/jbmr.4775).

Record type: Article

Abstract

Osteoporotic-related fractures cause significant patient disability, leading to a growing burden on health care systems. Effective secondary fracture prevention can be delivered by fracture liaison services (FLSs), but these are not available in most countries. A major barrier is insufficient policy prioritization, helped by the lack of economic assessments using national data and providing estimates of patient outcomes alongside health care resource use and cost impacts. The aim of this study was to develop an economic model to estimate the benefits and budget impact of FLSs and support their wider international implementation. Five interconnected stages were undertaken: establishment of a generic patient pathway; model design; identification of model inputs; internal validation and output generation; and scenario analyses. A generic patient pathway including FLS activities was built to underpin the economic model. A state-based microsimulation model was developed to estimate the impact of FLSs compared with current practice for men and women aged 50 years or older with a fragility fracture. The model provides estimates for health outcomes (subsequent fractures avoided and quality-adjusted life years [QALYs]), resource use, and health and social care costs, including those necessary for FLSs to operate, over 5 years. The model was run for an exemplar country the size of the United Kingdom. FLSs were estimated to lead to a reduction of 13,149 subsequent fractures and a gain of 11,709 QALYs. Hospital-bed days would be reduced by 120,989 and surgeries by 6455, while 3556 person-years of institutional social care would be avoided. Expected costs per QALY gained placed FLSs as highly cost-effective at £8258 per QALY gained over the first 5 years. Ten different scenarios were modeled using different configurations of FLSs. Further work to develop country-specific models is underway to delivery crucial national level data to inform the prioritization of FLSs by policy makers. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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J of Bone Mineral Res - 2023 - Pinedo‐Villanueva - Expected benefits and budget impact from a microsimulation model - Accepted Manuscript
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Accepted/In Press date: 15 January 2023
e-pub ahead of print date: 20 January 2023
Published date: April 2023
Additional Information: © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Keywords: ANABOLICS, FRACTURE PREVENTION, HEALTH ECONOMICS, HEALTH SERVICES RESEARCH, OSTEOPOROSIS

Identifiers

Local EPrints ID: 474797
URI: http://eprints.soton.ac.uk/id/eprint/474797
ISSN: 0884-0431
PURE UUID: e2b53602-5d71-4668-b306-366d114e5447
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 02 Mar 2023 17:50
Last modified: 18 Mar 2024 05:11

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Contributors

Author: Rafael Pinedo-Villanueva
Author: Edward Burn
Author: Christopher Maronga
Author: Cyrus Cooper ORCID iD
Author: M Kassim Javaid

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