Cost-effectiveness analysis of managed care for osteoporotic hip fractures

Abstract

Osteoporotic fracture patients are still unidentified, untreated for osteoporosis. This group of patients is likely to have recurrent fractures and has more morbidity, these problems put a burden on the high cost of taking care of patients and poor clinical outcomes. The intervention for improving the quality of osteoporosis treatment, King Chulalongkorn Memorial Hospital (KCMH) calls “Managed care”. Managed care has an orthopedist who plays a crucial role in fragility fracture and long-term osteoporosis treatment. The purpose of this study is to access the cost-effectiveness of managed care for patients aged 50 years and over with osteoporotic hip fractures compared to “Conventional care” which focuses on only perioperative management does not provide secondary fracture prevention.

The economic evaluation is used a Markov decision-analytic model to estimate the incremental cost and effectiveness of each group and used provider perspective. Conventional care is recruited from 2012 to 2013 (N=110), managed care is recruited from 2017 to 2019 (N=82). At a one-year follow-up, the study found that the death rate is decreasing from 11.8% in conventional care to 3.7% in managed care (P=0.045). The rate of the initiated osteoporosis drug, rate of BMD test, adherence, and the number of OPD visits are significant increases in managed care when compared to conventional care (P<0.001). For base-case analysis, the average cost of conventional care is 419,353 baht and yielded the average life-year gained at 8.2 life-year gained. In addition, the average cost of managed care is 263,474 baht and yielded the average life-year gained at 12.3 life-year gained. From the result of the incremental cost, the managed care is cost-saving at 38,019 baht for one additional life-year gained. In conclusion, managed care is post-fracture recurrent prevention which can be closed the osteoporosis treatment gap and decrease fracture complications after sustained osteoporotic hip fracture and is suggested to be cost-saving.