Real-world cost-effectiveness analysis of the fracture liaison services model of care for hip fracture in Taiwan

Li Nien Chien, Yi Fan Li, Rong Sen Yang, Tsung Han Yang, Yi Han Chen, Wei Jia Huang, Hsin Yi Tsai, Chun Yi Li, Ding Cheng Chan

Research output: Contribution to journalArticlepeer-review

Abstract

Background: This study was to perform an economic evaluation to understand clinical outcomes and health resource use between hip fracture patients receiving hospital-based postfracture fracture liaison service (FLS) care and those receiving usual care (UC) in Taiwan. Methods: This cohort study included hospital-based data of 174 hip fracture patients who received FLS care (FLS group) from National Taiwan University Hospital, and 1697 propensity score-matched patients who received UC (UC group) of National Health Insurance claim-based data. Two groups had similar baseline characteristics but differed in hip fracture care after propensity score matching. Clinical outcomes included refracture-free survival (RFS), hip-refracture-free survival (HRFS), and overall survival (OS). Health resource use included inpatient, outpatient, and pharmacy costs within 2 years follow-up after the index of hip fracture. The economic evaluation of the FLS model was analyzed using the net monetary benefit regression framework based on the National Health Insurance perspective. Results: The FLS group had longer RFS than the UC group, with an adjusted difference of 44.3 days (95% confidence interval: 7.2–81.4 days). Two groups did not differ in inpatient and outpatient costs during follow-up, but the FLS group had a higher expenditure than the UC group on osteoporosis-related medication. The probability of FLS being cost-effective was >80% and of increasing RFS, HRFS, and OS was 95%, 81%, and 80%, respectively, when the willingness-to-pay threshold was >USD 65/gross domestic product per day. Conclusion: FLS care was cost-effective in reducing refracture occurrence days for patients initially diagnosed with hip fractures.

Original languageEnglish
JournalJournal of the Formosan Medical Association
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • Cost-effectiveness analysis
  • Fracture liaison service (FLS)
  • Hip fracture
  • Net monetary benefit

ASJC Scopus subject areas

  • Medicine(all)

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