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Xu L, Yang M, Zhang X, Zhang J, He J, Wen L, Wang X, Shi Z, Hu S, Sun F, Gong Z, Sun M, Peng K, Ye P, Ma R, Wu X, Chen M, Jan S, Ivers R, Tian M, Si L. The cost-effectiveness of a co-managed care model for elderly hip fracture patients in China: a modelling study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 49:101149. [PMID: 39135908 PMCID: PMC11318548 DOI: 10.1016/j.lanwpc.2024.101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 08/15/2024]
Abstract
Background The clinical effectiveness of multidisciplinary co-managed care for hip fracture patients in China has been demonstrated in a multicenter non-randomized controlled study. This study aims to estimate the cost-effectiveness of the co-managed care. Methods The study is based on a multicenter clinical trial (n = 2071) in China. We developed a state transition microsimulation model to estimate the cost-effectiveness of the co-managed care compared with usual care for hip fracture patients from healthcare system perspective. The costs incorporated into the model included hospitalization costs, post-discharge expenses, and secondary fracture therapy costs. Effectiveness was measured using quality-adjusted life years (QALYs). Costs and effects were discounted at 5% annually. A simulation cycle length of 1-year and a lifetime horizon were employed. The cost-effectiveness threshold was established at USD 37,118. To address uncertainties, one-way deterministic sensitivity analysis and probabilistic sensitivity analysis were conducted. Findings In the base case analysis, the co-managed care group had a lifetime cost of USD 31,571 and achieved an effectiveness of 3.22 QALYs, whereas the usual care group incurred a cost of USD 27,878 and gained 2.85 QALYs. The incremental cost-effectiveness ratio was USD 9981 per QALY gained; thus the co-managed care model was cost-effective. The cost-effectiveness was sensitive to the age of having hip fractures and hospitalization costs in the intervention group. Interpretation The co-managed care in hip fracture patients represents value for money, and should be scaled up and prioritized for funding in China. Funding The study is supported by Capital's Funds for Health Improvement and Research (2022-1-2071, 2018-1-2071).
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Affiliation(s)
- Lizheng Xu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Xinyi Zhang
- School of Public Health, Harbin Medical University, Harbin, China
| | - Jing Zhang
- School of Public Health, Harbin Medical University, Harbin, China
| | - Jiusheng He
- Department of Orthopaedics, Beijing Shunyi District Hospital, Beijing, China
| | - Liangyuan Wen
- Department of Orthopaedics, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianhai Wang
- Department of Orthopaedics, Beijing Changping District Hospital, Beijing, China
| | - Zongxin Shi
- Department of Orthopaedics, Beijing Liangxiang Hospital, Beijing, China
| | - Sanbao Hu
- Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fengpo Sun
- Department of Orthopaedics, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zishun Gong
- Department of Orthopaedics, Beijing Liangxiang Hospital, Beijing, China
| | - Mingyao Sun
- Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ke Peng
- National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Pengpeng Ye
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Ruofei Ma
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Mingsheng Chen
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Stephen Jan
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, China
- Department of General Practice, The Second Affiliated Hospital of Harbin Medical University Harbin, China
| | - Lei Si
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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Hammes A, Smektala R, Halbach D, Müller-Mai C. [One-year outcomes after proximal humeral fractures : A risk-adjusted regression analysis of routine data based on 17,322 cases]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:870-876. [PMID: 37608117 DOI: 10.1007/s00104-023-01942-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Proximal humeral fractures (PHF) are the third most common fracture in geriatric traumatology. No standard evidence-based treatment has been established so far. The epidemiology and economic burden highlight the importance of a targeted treatment strategy. OBJECTIVE Epidemiology of PHF and analysis of the influence of preoperative length of stay, comorbidities and quality of patient life. Additionally, a comparison to the more frequently studied proximal femoral fractures. MATERIAL AND METHODS A routine data analysis of 17,322 cases admitted for inpatient treatment with an observational period of 1 year was performed following an established model. Descriptive statistics included comorbidities, treatment procedures and mortality. Analytical statistics using logistic regression with the primary endpoints of early revision, mortality and decubitus within 1 year. RESULTS In the investigated PHFs there was a mortality of 13% within 1 year, which is increased three-fold in patients with comorbidities such as cancer. There was an increase of 57% in patients who first received a care level following PHF. A preoperative care level in general significantly decreased survival. The most frequently used surgical procedure was fixation via stable-angle plate (used in 43%). The preoperative length of stay did not impact survival. DISCUSSION Intrinsic factors such as preoperative comorbidities are crucial for the mortality after PHF. The PHF affects patients' lives less than proximal femoral fractures. With comparable comorbidity profiles, possible reasons are the lower levels of immobilization and less dependency on care before the fracture in comparison to proximal femoral fractures.
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Affiliation(s)
- A Hammes
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deutschland.
| | - R Smektala
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deutschland
| | - D Halbach
- Knappschaft, Knappschaftstr. 1, 44799, Bochum, Deutschland
| | - C Müller-Mai
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deutschland
- Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, St. Marien Hospital, Altstadtstraße 23, 44534, Lünen, Deutschland
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Lesnyak O, Frolova E, Kuznetsova O, Lewiecki EM. A new digital case-based educational program Orthogeriatrics TeleECHO, a strategy to improve the care of fragility fracture patients. Arch Osteoporos 2023; 18:101. [PMID: 37466787 DOI: 10.1007/s11657-023-01311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
Participation in Orthogeriatrics TeleECHO was associated with improvement in physicians' knowledge and self-confidence in managing elderly patients with fractures. PURPOSE To develop and conduct an interactive case-based virtual TeleECHO program to expand the knowledge of healthcare professionals in the field of orthogeriatrics. METHODS The project included twelve 90-min sessions for physicians and healthcare managers. Each session was based on real clinical cases discussed by the multidisciplinary group of faculty. The efficacy of the project was assessed using questionnaires. RESULTS The attendance of individual sessions ranged from 129 to 224 with the total number of participants 829; 25% of participants were from remote rural regions. A survey conducted at the beginning of the project showed insufficient knowledge and ability to apply the concepts of orthogeriatrics. A final questionnaire showed that 74% of respondents participated in most sessions, with 94% wishing to continue participating in further sessions. There was a statistically significant overall improvement in confidence of caring for fragility fracture patients with an effect size of 0.75 (p<0.001). The proportion of responders who were able to apply their new knowledge in clinical practice shortly after TeleECHO showed a substantial increase (p<0.0001). CONCLUSION The Orthogeriatrics TeleECHO program was effective in changing perceptions and self-confidence of the participants, and applying knowledge acquired to patient care. This model of learning could be applied in other countries in other languages to improve post-fracture care worldwide.
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Affiliation(s)
- Olga Lesnyak
- North West State Medical University named after I.I. Mechnikov, St. Petersburg, Russia.
| | - Elena Frolova
- North West State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - Olga Kuznetsova
- North West State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
| | - E M Lewiecki
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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4
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Li N, van Oostwaard M, van den Bergh JP, Hiligsmann M, Boonen A, van Kuijk SMJ, Vranken L, Bours SPG, Wyers CE. Health-related quality of life of patients with a recent fracture attending a fracture liaison service: a 3-year follow-up study. Osteoporos Int 2022; 33:577-588. [PMID: 34671823 PMCID: PMC8843901 DOI: 10.1007/s00198-021-06204-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED This study explored the course of health state utility value over 3 years in patients with a recent fracture attending a Fracture Liaison Service and suggested that the overall change in health-related quality of life was not significant, although significant improvements were observed at 6 and 12 months compared to baseline. INTRODUCTION To estimate the 3-year health-related quality of life (HRQoL) of patients with a recent fracture presenting at a Fracture Liaison Service (FLS) and to explore factors associated with health state utility value (HSUV). METHODS Patients' HSUVs were derived from the EQ-5D-5L and SF-6D and calculated at six time points. Multiple imputation was applied for missing data. Linear mixed-effects regression analysis with random intercept and slope was applied to explore the course of HSUV over 3 years. The impact of subsequent fracture and the length of time between FLS visit and patients' index fracture on HSUV were also investigated. A backward stepwise elimination was applied to identify factors associated with HSUV. RESULTS A total of 499 patients were included. The change of EQ-5D HSUV was not significant over 3-year follow-up (P = 0.52), although slightly but significantly higher HSUV was captured at 6 months (mean difference (MD): 0.015, P = 0.02) and 12 months (MD: 0.018, P = 0.01). There was no significant difference in the course of EQ-5D HSUV between fracture locations (P = 0.86). A significant increase in HSUV was only captured for patients had shorter time period (< 107 days) between FLS visit and their index fracture. Suffering a subsequent fracture was associated with significant QoL loss (MD: - 0.078, P < 0.001). Subsequent fracture, previous treatment with anti-osteoporosis medication, a prevalent vertebral fracture (grade 2 or 3), use of a walking aid, previous falls, and higher BMI were negatively associated with mean EQ-5D HSUV over 3 years. Comparable results were found using SF-6D HSUV. The lack of HRQoL data immediately after fracture and selection bias were two main limitations. CONCLUSION The 3-year change in HSUV was not statistically significant, although significant improvements were observed at 6 and 12 months in comparison with baseline. Six factors were negatively associated with EQ-5D HSUV.
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Affiliation(s)
- N Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - M van Oostwaard
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Medicine, Hasselt University, Hasselt, Belgium
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - A Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L Vranken
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S P G Bours
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and CAPHRI Research Institute, Maastricht University, Maastricht, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, Medical Centre, VieCuri, Venlo, The Netherlands
- Department of Internal Medicine and NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
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Coassy A, Svedbom A, Locrelle H, Chapurlat R, Cortet B, Fardellone P, Orcel P, Roux C, Borgström F, Kanis JA, Thomas T. Costs of patient management over 18 months following a hip, clinical vertebral, distal forearm, or proximal humerus fragility fracture in France-results from the ICUROS study. Osteoporos Int 2022; 33:625-635. [PMID: 34642813 DOI: 10.1007/s00198-021-06189-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED This observational study prospectively assessed direct and indirect costs related to patient management over 18 months following hip, clinical vertebral, humeral, or distal forearm fracture events in France. It appears that their levels were much higher than the previous estimates, raising the burden of osteoporosis-related fractures on public health expenditures. INTRODUCTION This prospective observational study assessed the costs related to patient management over the 18-month period following the event of a hip, clinical vertebral, humeral, or distal forearm fracture in France. METHODS Individuals aged ≥ 50 years old with the diagnosis of a fragility fracture in six French University Hospitals were enrolled in the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS). All resources used over the defined period and related to fracture and the underlying osteoporosis management were collected by questionnaires at baseline, 4 months, 12 months, and 18 months. Information was collected by direct or phone contact completed by patients' records and interviews of partner, family, and general practitioners. Costs were estimated from a societal perspective, including direct and indirect costs. We implemented recursive partitioning analysis (RPA), a statistical learning algorithm to identify predictors of costs. RESULTS Four hundred thirty-one patients (mean age 72.5 years; 84.6% women) were evaluated. Among them, 17.6% had a prior fracture in the last 5 years. Approximately half of the whole group lived alone in the community, and 56.8% were from a low- or middle-income category. Over the 18-month period of evaluation, total costs (including initial fracture-related and follow-up ones) were 23 926 €, 14 561 €, and 6 905 € for the hip, clinical vertebral, and distal forearm fracture, respectively. Over a year, costs related to a humeral fracture were 10 319 €. The RPA identified mobility impairment prior to fracture as a predictor of increase in costs related to fracture. CONCLUSIONS Our study for the first time prospectively assessed total costs related to the four main osteoporotic fractures in France. It appears that their levels were much higher than previous estimates, raising the burden of osteoporosis-related fractures on public health expenditures.
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Affiliation(s)
- Astrid Coassy
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
- INSERM U1059, Université de Lyon, Université Jean Monnet, Saint-Etienne, France
| | | | - Hervé Locrelle
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | | | | | | | - Philippe Orcel
- Hôpitaux Universitaires Saint-Louis-Lariboisière-Fernand-Widal, AP-HP-Inserm UMR132 BIOSCAR, Université Paris Diderot, Paris, France
| | - Christian Roux
- Hôpital Cochin, AP-HP - INSERM U1153, Université Paris Descartes, Paris, France
| | - Fredrik Borgström
- Karolinska Institut, Stockholm, Sweden
- Quantify Research, Stockholm, Sweden
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Thierry Thomas
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France.
- INSERM U1059, Université de Lyon, Université Jean Monnet, Saint-Etienne, France.
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Talevski J, Sanders KM, Busija L, Beauchamp A, Duque G, Borgström F, Kanis JA, Svedbom A, Connaughton C, Stuart AL, Brennan-Olsen SL. Health Service Use and Quality of Life Recovery 12 Months Following Major Osteoporotic Fracture: Latent Class Analyses of the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS). J Bone Miner Res 2021; 36:252-261. [PMID: 32960460 DOI: 10.1002/jbmr.4181] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 01/20/2023]
Abstract
Major osteoporotic fractures (MOFs) are associated with a rapid decline in health-related quality of life (HRQoL); however, there is limited knowledge about which healthcare services positively affect HRQoL postfracture. This study aimed to identify specific combinations of health service use associated with recovery of HRQoL 12 months post-MOF. The analyses included 4126 adults aged ≥50 years with an MOF (1657 hip, 1354 distal forearm, 681 vertebrae, 434 humerus) participating in the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS), a multinational observational study (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, United Kingdom, and United States). HRQoL at prefracture and 12 months postfracture was measured using the EuroQoL questionnaire (EQ-5D-3L). Health service use data were collected via participant interviews and medical record reviews including in-hospital care; outpatient care; community services; and medication use. Data analyses involved two stages: (i) latent class analyses to identify different combinations of health service use ("classes"); and (ii) logistic regression to assess effects of classes on HRQoL recovery. Analyses were repeated excluding hip fractures (non-hip MOFs). Overall, 2057 MOF participants (49.9%) recovered to their prefracture HRQoL at 12-month follow-up; this proportion was higher for non-hip MOFs (n = 1439; 58.3%). Several distinct classes were identified across countries (range, 2-5 classes). Classes that were associated with increased odds of HRQoL recovery were characterized by a combination of hospital presentations without admission; outpatient department visits; allied health visits; vitamin D/calcium supplementation; and/or non-opioid analgesic use. Similar classes were observed for non-hip MOFs. Understanding country-specific healthcare service pathways that influence greater recovery of HRQoL, particularly services that are uncommon in some countries and routine in others, could improve postfracture care on a global scale. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Jason Talevski
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Kerrie M Sanders
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Ljoudmila Busija
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Alison Beauchamp
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Rural Health, Monash University, Clayton, VIC, Australia
| | - Gustavo Duque
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Fredrik Borgström
- Quantify Research, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - John A Kanis
- Mary McKillop Institute for Research, Australian Catholic University, Ballarat, VIC, Australia.,Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | | | - Catherine Connaughton
- Melbourne Academic Centre for Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Amanda L Stuart
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia.,School of Health and Social Development, Deakin University, Geelong, VIC, Australia.,Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
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Ito K. Cost-effectiveness of Screening for Osteoporosis in Older Men With a History of Falls. JAMA Netw Open 2020; 3:e2027584. [PMID: 33258906 PMCID: PMC7708999 DOI: 10.1001/jamanetworkopen.2020.27584] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/06/2020] [Indexed: 12/01/2022] Open
Abstract
Importance Falls and osteoporosis share the potential clinical end point of fractures among older patients. To date, few fall prevention guidelines incorporate screening for osteoporosis to reduce fall-related fractures. Objective To assess the cost-effectiveness of screening for osteoporosis using dual-energy x-ray absorptiometry (DXA) followed by osteoporosis treatment in older men with a history of falls. Design, Setting, and Participants In this economic evaluation, a Markov model was developed to simulate the incidence of major osteoporotic fractures in a hypothetical cohort of community-dwelling men aged 65 years who had fallen at least once in the past year. Data sources included literature published from January 1, 1946, to July 31, 2020. The model adopted a societal perspective, a lifetime horizon, a 1-year cycle length, and a discount rate of 3% per year for both health benefits and costs. The analysis was designed and conducted from October 1, 2019, to September 30, 2020. Interventions Screening with DXA followed by treatment for men diagnosed with osteoporosis compared with usual care. Main Outcomes and Measures Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. Results Among the hypothetical cohort of men aged 65 years, the screening strategy had an ICER of $33 169/QALY gained and was preferred over usual care at the willingness-to-pay threshold of $100 000/QALY gained. The number needed to screen to prevent 1 hip fracture was 1876; to prevent 1 major osteoporotic fracture, 746. The screening strategy would become more effective and less costly than usual care for men 77 years and older. The ICER for the screening strategy did not substantially change across a wide range of assumptions tested in all other deterministic sensitivity analyses. At a willingness-to-pay threshold of $50 000/QALY gained, screening was cost-effective in 56.0% of simulations; at $100 000/QALY gained, 90.8% of simulations; and at $200 000/QALY gained, 99.6% of simulations. Conclusions and Relevance These findings suggest that for older men who have fallen at least once in the past year, screening with DXA followed by treatment for those diagnosed with osteoporosis is a cost-effective use of resources. Fall history could be a useful cue to trigger assessment for osteoporosis in men.
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Affiliation(s)
- Kouta Ito
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
- Meyers Primary Care Institute, Worcester, Massachusetts
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Report on the Audit on Burden of Osteoporosis in Eight Countries of the Eurasian Region: Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan. Arch Osteoporos 2020; 15:175. [PMID: 33156448 DOI: 10.1007/s11657-020-00836-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED The audit provides a detailed analysis of the burden of osteoporosis and differences between Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan with regard to prevalence of osteoporosis and incidence of osteoporotic fractures, future demographic changes, diagnostic resources, and treatment availability. PURPOSE This paper describes the results of the Audit on Burden of Osteoporosis in Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan. METHODS We carried out a review of the available literature and a survey of the representatives of the national osteoporosis societies. All the information available in English, Russian, or national languages including the publications of local or regional importance was analyzed. RESULTS The expected number of osteoporosis patients varies from 240,000 in Armenia to 16 million in Russia. Low-energy fractures are a serious health problem in all countries with the highest incidence in Kazakhstan and Russia. The rate of hip fracture patients' hospitalization in the majority of countries is low (33-80%). In the coming decades the populations, in particular, in Uzbekistan, Kazakhstan, and Kyrgyzstan, will continue to show increases in life expectancy with a corresponding increase in the number of fractures in older people. Thus, in 2050, the number of hip fractures in these countries will increase by 2.5-3.5 times. However, the availability of DXA devices in the region is low (0.2-1.3 per million), and DXA tests are expensive. Almost all modern treatments for osteoporosis are available, but the costs are high even for alendronate. Urgent action is needed at the national level in each country including recognition of osteoporosis as a priority health issue. CONCLUSION Osteoporosis is an important health problem in the countries of the Eurasian region that will only get worse in the future due to expected demographic changes.
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