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

Abstract

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.