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Sumit R. Majumdar, Douglas A. Lier, William D. Leslie, Cost-Effectiveness of Two Inexpensive Postfracture Osteoporosis Interventions: Results of a Randomized Trial, The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 5, 1 May 2013, Pages 1991–2000, https://doi.org/10.1210/jc.2013-1034
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Most older patients are not treated for osteoporosis after fragility fracture. In a 3-armed randomized trial, we reported that 2 inexpensive mail-based interventions, one directed at physicians and the other at physicians plus patients, increased 1-year osteoporosis treatment starts by 4% and 6% (respectively) compared with usual care starts of 11%. The cost-effectiveness of these interventions is unknown.
The incremental cost-effectiveness of interventions compared with usual care was assessed using Markov decision-analytic models. Costs were expressed in 2010 Canadian dollars and long-term effectiveness based on quality-adjusted life years (QALYs) gained derived from hypothetical model simulations. The perspective was third-party health care payer; the time horizon was lifetime; and the costs and benefits were discounted 3%.
The physician intervention cost was $7.12 per patient, whereas the physician plus patient intervention cost was $8.45. Compared with usual care, the economic simulation demonstrated that for every 1000 patients getting the physician intervention, there were 2 fewer fractures, 2 more QALYs gained, and $22,000 saved. Compared with physician intervention, the simulation demonstrated that for every 1000 patients receiving physician plus patient intervention, there was 1 fewer fracture and 1 more QALY gained, with $18,000 saved. Both interventions dominated usual care and were cost saving or highly cost effective in 67% of 10 000 probabilistic simulations. Although the physician plus patient intervention cost was $1.33 more per patient than the physician intervention, it was still the most economically attractive option.
Pragmatic mail-based interventions directed at patients with recent fractures and their physicians are a highly cost-effective means to improving osteoporosis management and both interventions dominated usual care.
