Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture

Majumdar, Sumit R.; Lier, Doug; Rowe, Brian H.; Russell, Anthony S.; McAlister, Finlay A.; Maksymowych, W.P.; Hanley, David A.; Morrish, Don; Johnson, Jeffrey

doi:10.1007/s00198-010-1412-1

Cited by 39 publications

(30 citation statements)

References 25 publications

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“…During the same period, hip fracture rates for the entire population of England had increased by almost 17%. These findings are broadly consistent with observational data reported by Dell and colleagues for the Kaiser Healthy Bones Program in the USA [23] and randomized control trial data reported by Majumdar and colleagues from Canada [24,25].…”

Section: Fracture Case Findingsupporting

confidence: 82%

Fracture Liaison Services: the UK experience

Mitchell

2011

Osteoporos Int

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Fracture Liaison Services (FLS) have been shown to deliver clinically and cost-effective osteoporosis care for patients presenting to hospital with fragility fractures. During the first decade of the new millennium, a consensus emerged in the UK on the need for universal access to FLS. This presentation described constructive interactions between policy makers, professional organizations, patients and their associations, and pharmaceutical manufacturers that led to the incorporation of FLS into national policy and guidance.

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Section: Fracture Case Findingsupporting

confidence: 82%

Fracture Liaison Services: the UK experience

Mitchell

2011

Osteoporos Int

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“…The use of a care coordinator to identify patients who have suffered a fragility fracture and to coordinate care within a multidisciplinary team has been demonstrated to significantly increase both the diagnosis and the treatment of osteoporosis following a fragility fracture [17,[22][23][24][25][26][27][28][29][30]. Furthermore, the use of a care coordinator has been demonstrated to be cost-effective [25,31,32]: Irrespective of the number of patients receiving case-managed care, the intervention reached a break-even threshold within 2 years. Limitations to this study include self-reporting of much of the data and a lack of information regarding vertebral fractures; non-vertebral fractures represent approximately 75% of all osteoporotic fractures.…”

Section: Discussionmentioning

confidence: 99%

The impact of two educational interventions on osteoporosis diagnosis and treatment after fragility fracture: a population-based randomized controlled trial

et al. 2011

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“…Both estimated the number of future hip fractures prevented and conducted sensitivity analyses that demonstrated a robust model with the coordinator programme dominant over usual care. Majumdar and colleagues [83] showed that the intervention cost $12 per patient and, for every 100 patients receiving the intervention, 3 fractures (1 hip fracture) would be prevented, 1.1 quality-adjusted life year gained, and $26,800 saved by the healthcare system over their remaining lifetime. A recent health economic analysis has established that the Glasgow FLS, in the UK, is cost-effective for the prevention of secondary fractures and is cost-saving.…”

Section: Cost-effectiveness Of Coordinator-based Systemsmentioning

confidence: 98%

Coordinator-based systems for secondary prevention in fragility fracture patients

et al. 2011

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The underlying causes of incident fractures--bone fragility and the tendency to fall--remain under-diagnosed and under-treated. This care gap in secondary prevention must be addressed to minimise both the debilitating consequences of subsequent fractures for patients and the associated economic burden to healthcare systems. Clinical systems aimed at ensuring appropriate management of patients following fracture have been developed around the world. A systematic review of the literature showed that 65% of systems reported include a dedicated coordinator who acts as the link between the orthopaedic team, the osteoporosis and falls services, the patient and the primary care physician. Coordinator-based systems facilitate bone mineral density testing, osteoporosis education and care in patients following a fragility fracture and have been shown to be cost-saving. Other success factors included a fracture registry and a database to monitor the care provided to the fracture patient. Implementation of such a system requires an audit of existing arrangements, creation of a network of healthcare professionals with clearly defined roles and the identification of a 'medical champion' to lead the project. A business case is needed to acquire the necessary funding. Incremental, achievable targets should be identified. Clinical pathways should be supported by evidence-based recommendations from national or regional guidelines. Endorsement of the proposed model within national healthcare policies and advocacy programmes can achieve alignment of the objectives of policy makers, professionals and patients. Successful transformation of care relies upon consensus amongst all participants in the multi-disciplinary team that cares for fragility fracture patients.

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Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture

Abstract: 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.

Cited by 39 publications

References 25 publications

Fracture Liaison Services: the UK experience

Fracture Liaison Services: the UK experience

The impact of two educational interventions on osteoporosis diagnosis and treatment after fragility fracture: a population-based randomized controlled trial

Coordinator-based systems for secondary prevention in fragility fracture patients

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