Fracture liaison service utilising an emergency department information system to identify patients effectively reduce re-fracture rate is cost-effective and cost saving in Western Australia
Objectives: To assess the benefits of the Emergency Department Information System (EDIS)-linked fracture liaison service (FLS). Methods: Patients identified through EDIS were invited to attend an FLS at the intervention hospital, the Sir Charles Gairdner Hospital (SCGS-FLS). The intervention group w...
| Main Authors: | , , , , , |
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| Format: | Journal Article |
| Language: | English |
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WILEY
2022
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| Online Access: | http://purl.org/au-research/grants/nhmrc/1132548 http://hdl.handle.net/20.500.11937/93331 |
| _version_ | 1848765722724925440 |
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| author | Inderjeeth, C.A. Raymond, W.D. Geelhoed, E. Briggs, Andrew Oldham, D. Mountain, D. |
| author_facet | Inderjeeth, C.A. Raymond, W.D. Geelhoed, E. Briggs, Andrew Oldham, D. Mountain, D. |
| author_sort | Inderjeeth, C.A. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Objectives: To assess the benefits of the Emergency Department Information System (EDIS)-linked fracture liaison service (FLS). Methods: Patients identified through EDIS were invited to attend an FLS at the intervention hospital, the Sir Charles Gairdner Hospital (SCGS-FLS). The intervention group was compared to usual care. Retrospective control (RC) at this hospital determined historical fracture risk (SCGH-RC). Prospective control (PC) was from a comparator, Fremantle Hospital (FH-PC). The main outcome measures were cost-effectiveness from a health system perspective and quality of life by EuroQOL (EQ-5D). Bottom-up cost of medical care, against the cost of managing recurrent fracture (weighted basket), was determined from the literature and 2013/14 Australian Refined Diagnosis Related Groups (AR-DRG) prices. Mean incremental cost-effectiveness ratios were simulated from 5000 bootstrap iterations. Cost-effectiveness acceptability curves were generated. Results: The SCGH-FLS program reduced absolute re-fracture rates versus control cohorts (9.2–10.2%), producing an estimated cost saving of AUD$750,168–AUD$810,400 per 1000 patient-years in the first year. Between-groups QALYs differed with worse outcomes in both control groups (p < 0.001). The SCGH-FLS compared with SCGH-RC and FH-PC had a mean incremental cost of $8721 (95% CI −$1218, $35,044) and $8974 (95% CI −$26,701, $69,929), respectively, per 1% reduction in 12-month recurrent fracture risk. The SCGH-FLS compared with SCGH-RC and FH-PC had a mean incremental cost of $292 (95% CI −$3588, $3380) and −$261 (95% CI −$1521, $471) per EQ-5D QALY gained at 12 months respectively. With societal willingness to pay of $16,000, recurrent fracture is reduced by 1% in >80% of patients. Conclusions: This simple and easy model of identification and intervention demonstrated efficacy in reducing rates of recurrent fracture and was cost-effective and potentially cost saving. |
| first_indexed | 2025-11-14T11:39:46Z |
| format | Journal Article |
| id | curtin-20.500.11937-93331 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:39:46Z |
| publishDate | 2022 |
| publisher | WILEY |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-933312023-10-12T01:05:35Z Fracture liaison service utilising an emergency department information system to identify patients effectively reduce re-fracture rate is cost-effective and cost saving in Western Australia Inderjeeth, C.A. Raymond, W.D. Geelhoed, E. Briggs, Andrew Oldham, D. Mountain, D. Science & Technology Life Sciences & Biomedicine Geriatrics & Gerontology Gerontology analyses cost benefit fractures health care economics and organizations integrated health care systems osteoporotic prevention secondary OSTEOPOROTIC FRACTURE TRAUMA FRACTURE MANAGEMENT CARE INTERVENTION PREVALENCE IMPROVE RISK MEN analyses cost benefit fractures health care economics and organizations integrated health care systems osteoporotic prevention secondary Australia Cost Savings Cost-Benefit Analysis Emergency Service, Hospital Humans Information Systems Osteoporotic Fractures Prospective Studies Quality of Life Retrospective Studies Western Australia Humans Retrospective Studies Prospective Studies Quality of Life Information Systems Emergency Service, Hospital Cost-Benefit Analysis Cost Savings Australia Western Australia Osteoporotic Fractures Objectives: To assess the benefits of the Emergency Department Information System (EDIS)-linked fracture liaison service (FLS). Methods: Patients identified through EDIS were invited to attend an FLS at the intervention hospital, the Sir Charles Gairdner Hospital (SCGS-FLS). The intervention group was compared to usual care. Retrospective control (RC) at this hospital determined historical fracture risk (SCGH-RC). Prospective control (PC) was from a comparator, Fremantle Hospital (FH-PC). The main outcome measures were cost-effectiveness from a health system perspective and quality of life by EuroQOL (EQ-5D). Bottom-up cost of medical care, against the cost of managing recurrent fracture (weighted basket), was determined from the literature and 2013/14 Australian Refined Diagnosis Related Groups (AR-DRG) prices. Mean incremental cost-effectiveness ratios were simulated from 5000 bootstrap iterations. Cost-effectiveness acceptability curves were generated. Results: The SCGH-FLS program reduced absolute re-fracture rates versus control cohorts (9.2–10.2%), producing an estimated cost saving of AUD$750,168–AUD$810,400 per 1000 patient-years in the first year. Between-groups QALYs differed with worse outcomes in both control groups (p < 0.001). The SCGH-FLS compared with SCGH-RC and FH-PC had a mean incremental cost of $8721 (95% CI −$1218, $35,044) and $8974 (95% CI −$26,701, $69,929), respectively, per 1% reduction in 12-month recurrent fracture risk. The SCGH-FLS compared with SCGH-RC and FH-PC had a mean incremental cost of $292 (95% CI −$3588, $3380) and −$261 (95% CI −$1521, $471) per EQ-5D QALY gained at 12 months respectively. With societal willingness to pay of $16,000, recurrent fracture is reduced by 1% in >80% of patients. Conclusions: This simple and easy model of identification and intervention demonstrated efficacy in reducing rates of recurrent fracture and was cost-effective and potentially cost saving. 2022 Journal Article http://hdl.handle.net/20.500.11937/93331 10.1111/ajag.13107 English http://purl.org/au-research/grants/nhmrc/1132548 http://creativecommons.org/licenses/by/4.0/ WILEY fulltext |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Geriatrics & Gerontology Gerontology analyses cost benefit fractures health care economics and organizations integrated health care systems osteoporotic prevention secondary OSTEOPOROTIC FRACTURE TRAUMA FRACTURE MANAGEMENT CARE INTERVENTION PREVALENCE IMPROVE RISK MEN analyses cost benefit fractures health care economics and organizations integrated health care systems osteoporotic prevention secondary Australia Cost Savings Cost-Benefit Analysis Emergency Service, Hospital Humans Information Systems Osteoporotic Fractures Prospective Studies Quality of Life Retrospective Studies Western Australia Humans Retrospective Studies Prospective Studies Quality of Life Information Systems Emergency Service, Hospital Cost-Benefit Analysis Cost Savings Australia Western Australia Osteoporotic Fractures Inderjeeth, C.A. Raymond, W.D. Geelhoed, E. Briggs, Andrew Oldham, D. Mountain, D. Fracture liaison service utilising an emergency department information system to identify patients effectively reduce re-fracture rate is cost-effective and cost saving in Western Australia |
| title | Fracture liaison service utilising an emergency department information system to identify patients effectively reduce re-fracture rate is cost-effective and cost saving in Western Australia |
| title_full | Fracture liaison service utilising an emergency department information system to identify patients effectively reduce re-fracture rate is cost-effective and cost saving in Western Australia |
| title_fullStr | Fracture liaison service utilising an emergency department information system to identify patients effectively reduce re-fracture rate is cost-effective and cost saving in Western Australia |
| title_full_unstemmed | Fracture liaison service utilising an emergency department information system to identify patients effectively reduce re-fracture rate is cost-effective and cost saving in Western Australia |
| title_short | Fracture liaison service utilising an emergency department information system to identify patients effectively reduce re-fracture rate is cost-effective and cost saving in Western Australia |
| title_sort | fracture liaison service utilising an emergency department information system to identify patients effectively reduce re-fracture rate is cost-effective and cost saving in western australia |
| topic | Science & Technology Life Sciences & Biomedicine Geriatrics & Gerontology Gerontology analyses cost benefit fractures health care economics and organizations integrated health care systems osteoporotic prevention secondary OSTEOPOROTIC FRACTURE TRAUMA FRACTURE MANAGEMENT CARE INTERVENTION PREVALENCE IMPROVE RISK MEN analyses cost benefit fractures health care economics and organizations integrated health care systems osteoporotic prevention secondary Australia Cost Savings Cost-Benefit Analysis Emergency Service, Hospital Humans Information Systems Osteoporotic Fractures Prospective Studies Quality of Life Retrospective Studies Western Australia Humans Retrospective Studies Prospective Studies Quality of Life Information Systems Emergency Service, Hospital Cost-Benefit Analysis Cost Savings Australia Western Australia Osteoporotic Fractures |
| url | http://purl.org/au-research/grants/nhmrc/1132548 http://hdl.handle.net/20.500.11937/93331 |