The Costs of Confronting Osteoporosis: Cost Study of an Australian Fracture Liaison Service

Fracture liaison services (FLS) are an accepted approach to lowering rates of osteoporotic re-fractures. However, resource allocations to FLSs are open to challenge, as most relevant cost analyses are based on anticipated, rather than observed, benefits. To support informed decision making we have estimated the cost of operating an FLS, from the perspective of the Australian health system, with real life costs. On the basis of hospital records, we compared total costs of two cohorts of patients presenting with minimal trauma fractures (MTFs) at two hospital emergency departments (EDs) across a 6 month period (July to December 2010). The treatment cohort (FLS Cohort, n = 515) attended an ED at a hospital offering FLS post-fracture care; the Usual Care Cohort (n = 416) attended an ED at a hospital without an FLS. Hospital records were reviewed for further attendance of both groups at their respective hospitals EDs with re-fractures, for the subsequent three years. Costs were constructed from ‘bottom up’ with a ‘microcosting’ approach. Total costs for both cohorts included any FLS and the costs of re-fractures. Cohort costs were estimated for every 1,000 patients over the three observed years. Compared to the Usual Care Cohort, the FLS Cohort had 62 fewer fractures per 1,000 patients and $617,275 lower costs over three years. In a sensitivity analysis, where 20% of the Usual Care Cohort received FLS preventative treatment, FLS Cohort costs were lower by $880,154. As both hospitals consistently process around 2,000 patients per year, the estimated annual saving is $1.2 million to $1.8 million AUD. From the perspective of the Australian public health system, investment in FLS can be a financially effective way of reducing the cost of osteoporotic fracture management. This article is protected by copyright. All rights reserved