This presentation is part of: Poster Session - CEA: Methods and Applications; Health Services Research
TARGETING FRAGILITY FRACTURES IN AN ORTHOPAEDIC TREATMENT UNIT: COSTEFFECTIVENESS OF A DEDICATED COORDINATOR
Beate Sander, RN, MEcDev1, Andreas Maetzel, MD, PhD1, Victoria Elliot-Gibson, MSc2, Dorcas E. Beaton, PhD2, and Earl R. Bogoch, MD2. (1) University Health Network, Division of Clinical Decision Making, Toronto, ON, Canada, (2) St. Michael's Hospital Hospital, Mobility Program Clinical Research Unit, Toronto, ON, Canada
Purpose:The orthopaedic unit at a university teaching hospital hired an osteoporosis (OP) coordinator to manage a collaborative program to identify fragility fracture patients and arrange for investigation and treatment of OP, and patient education. This analysis evaluates the cost-effectiveness of a coordinator in avoiding inpatient hospitalizations due to further hip fractures from the hospital perspective. Methods: A 1-year decision analytic model was developed combining data from the literature and patient-level data from the first year of the program, during which 430 patients entered the study: age 71 +/- 14, female n = 333 (77%), index fracture hip (n =1 85, 43%), wrist (n = 124, 29%), humerus (n = 72, 17%) and other (n = 49; 11%); OP most likely cause of fracture n = 349 (81%). The decision analysis model calculates the annual incidence of a further hip fracture dependent on type of index fracture (hip, wrist, humerus, other), attribution to OP, age and gender. Referral uptake, initiation of OP treatment and compliance modified the incidence of further hip fractures in the presence of a coordinator. The relative risk of further hip fracture varied from 3.2 to 9.8 depending on the index fracture. Average direct hospital cost of $21,800 for the subset of patients with an index hip fracture were used as a surrogate for the cost of a potential further hip fracture; the cost of a coordinator was $60,000 + 30% benefits. Results: Baseline cost-effectiveness analysis showed that a coordinator who manages 500 patients yearly would reduce further hip fractures from 30 to 21, saving the hospital $104,000. A coordinator was cost-saving: 1) over reasonable cost ranges, 2) if only half of patients initiated treatment and only half complied, 3) if treatment efficacy reduced fractures by as low as 20% and 4) if only 220 patients were seen annually. Conclusion: Employment of a coordinator to manage fragility fracture patients may reduce further hip fractures and is cost-effective from the hospital's perspective. This analysis did not estimate the full benefit of a coordinator on the prevention of other fractures. The results may change, when expanding the model to include all relevant costs from a societal perspective.
