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Xu L, Zhao T, Perry L, Frost SA, Di Tanna GL, Wang S, Chen M, Kolt GS, Jan S, Si L. Return on investment of fracture liaison services: a systematic review and analysis. Osteoporos Int 2024; 35:951-969. [PMID: 38300316 DOI: 10.1007/s00198-024-07027-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
Fracture liaison services (FLS) have been proven clinically effective and cost-effective in preventing subsequent fractures among patients with an existing fragility fracture. Little is known about their monetary benefits such as their return on investment (ROI). This systematic review aimed to investigate the ROI of FLS and identify the FLS characteristics with better ROI. Studies on the cost-effectiveness of FLS published between January 2000 and December 2022 were searched from MEDLINE, EMBASE, PubMed, and Cochrane Central. Two independent reviewers conducted study selection and data extraction. ROI was calculated based on the difference between monetary benefits and FLS costs divided by the FLS costs. Subgroup analysis of ROI was performed across FLS types and FLS design details. A total of 23 FLS were included in this review. The majority of them were targeting patients aged over 50 years having fractures without identified sites. The mean ROI of these FLS was 10.49 (with a median ROI of 7.57), and 86.96% of FLS had positive ROI. FLS making treatment recommendations yielded the highest ROI (with a mean ROI of 18.39 and a median of 13.60). Incorporating primary care providers (with a mean ROI of 16.04 and a median of 13.20) or having them as program leaders (with a mean ROI of 12.07 and a median of 12.07) has demonstrated a high ROI. FLS for specific fracture sites had great monetary return. Intensive FLS such as type A and B FLS programs had higher ROI than non-intensive type C and D FLS. This review revealed a 10.49-fold monetary return of FLS. Identified characteristics contributing to greater economic return informed value-for-money FLS designs. Findings highlight the importance of FLS and the feasibility of expanding their contribution in mitigating the economic burden of osteoporotic fracture and are conducive to the promotion of FLS internationally.
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Affiliation(s)
- L Xu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - T Zhao
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - L Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- South Eastern Sydney Local Health District, Randwick, New South Wales, Australia
| | - S A Frost
- University of Wollongong and South Western Sydney Local Health District, Wollongong, New South Wales, Australia
| | - G L Di Tanna
- Department of Business Economics, Health & Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - S Wang
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - M Chen
- School of Health Policy and Management, Nanjing Medical University, No. 101, Longmian Avenue, Nanjing, 211166, China.
| | - G S Kolt
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - S Jan
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - L Si
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
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Li Q, Yang J, Tang Q, Feng Y, Pan M, Che M, Shi J, Zeng Y. Age-dependent gender differences in the diagnosis and treatment of osteoporosis during hospitalization in patients with fragility fractures. BMC Geriatr 2023; 23:728. [PMID: 37946131 PMCID: PMC10636910 DOI: 10.1186/s12877-023-04430-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND There is a gender difference in the acceptance of osteoporosis diagnosis and treatment in patients after fragility fractures, but this difference is rarely assessed during hospitalization, and it is unclear whether these differences are age-dependent. This study aimed to evaluate the differences between male and female fragility fracture patients of different age groups who received the diagnosis and treatment of osteoporosis during hospitalization. METHODS 31,265 fragility fracture patients aged ≥ 50 years from the Fragility Fracture Management Database in a high-volume orthopedic hospital from December 2019 to February 2023 were included in this study. We compared the differences in the rates of men and women with fragility fracture who received the measurement of bone mineral density (BMD) and bone metabolism biochemical markers (BMBMs) and treatment with anti-osteoporosis medications (AOMs), and follow-up to the internal medicine clinic within 3 months after discharge, across all age groups and across different age stages (50-59, 60-69, 70-79, and ≥ 80 years). RESULTS The detection rates of female patients receiving BMD and BMBMs during hospitalization were 31.88% and 5.30%, respectively, compared with 22.23% and 2.69% for men. The rate of receiving any AOMs treatment was 44.63% for women and 31.60% for men. The follow-up rate of returning to the internal medicine clinic within 3 months after discharge was 9.79% for women compared to 3.00% for men. There was a significant difference between males compared to females (P < 0.0001). Analysis of patients by different age group revealed that differences in the diagnosis and treatment of osteoporosis were found only in patients under 80 years of age, while gender differences in the return to the internal medicine clinic for follow-up after discharge were present in all age groups. CONCLUSIONS Gender differences present in osteoporosis management in patients with fragility fracture during hospitalization, especially for patients under 80 years of age. This finding suggests that orthopedic surgeons neglect to manage osteoporosis in male patients with fragility fracture during hospitalization.
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Affiliation(s)
- Qingmei Li
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Jiancheng Yang
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Qinghua Tang
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Yan Feng
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Mingming Pan
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Maohong Che
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Jie Shi
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China
| | - Yuhong Zeng
- Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, NanShaomen, Beilin District, Xi'an, 710054, China.
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