MedWire News: Implementation of an osteoporosis case manager leads to a reduction in osteoporosis-related fractures, a gain in life expectancy, and substantial cost savings, Canadian researchers report.
In a randomized trial of patients with hip fractures, Sumit Majumdar (University of Alberta, Edmonton) and colleagues previously demonstrated that a hospital-based osteoporosis case manager could increase rates of appropriate osteoporosis treatment to 51% compared with 22% for usual-care controls.
“Although the osteoporosis case manager was effective and led to clinically meaningful improvements in quality of care, physicians, policy makers, and payers may remain unconvinced that the intervention would be worth the effort or cost of implementation,” say the researchers.
Therefore, alongside the randomized trial, Majumdar and team conducted a formal health economic analysis from the perspective of a third-party healthcare payer.
In the primary trial, patients with hip fractures were randomly assigned to receive usual care (n=110) or care from a case manager (n=110) and followed-up for 1 year. Time-motion studies were used to determine intervention costs.
The researchers used a decision analysis model incorporating Markov processes to simulate the osteoporosis experience of a cohort of patients with hip fracture similar to those in the randomized trial, but followed-up over the rest of their projected remaining lifetime.
They calculated that the case manager intervention cost CAD $56 (US $44; €35) per patient.
The cost effectiveness model revealed that the case manager intervention strategy dominated usual care: for every 100 patients case managed, six fractures (four hip fractures) were prevented, 4 quality-adjusted life-years were gained, and CAD $260,000 (US $227,000; €161,213) was saved by the healthcare system.
Furthermore, the intervention reached a break-even threshold within 2 years, irrespective of the number of patients case managed. It remained the dominant strategy compared with usual care for all sensitivity analyses and was cost saving in 82% of probabilistic model simulations.
“Compared with usual care, we found that a pragmatic and inexpensive case-manager intervention for patients with hip fractures led to marked improvements in testing and treatment for osteoporosis,” conclude Majumdar and co-authors in the Archives of Internal Medicine.
Free abstract
