Cost Analysis of a Fracture Liaison System (FLS): A Prospective-Randomized Study for Secondary Prevention after Fractures of the Hip

Background:
Fracture liaison systems (FLS) have proven to be effective in treating osteoporosis associated with fragility fractures. Given the high risk of re-fracture and the high cost of fracture treatment, hip fracture patients present a unique opportunity for FLS care. Creating and managing a FLS system may be expensive in the short-term but is assumed to be cost-effective in the long-term by preventing future losses associated with treating secondary fractures. In this study we evaluate the essential factors in determining whether the FLS system saves or loses more than it costs.

Methods:
A prospective-randomized study was done in patients with hip fragility fractures using a hospital-based FLS system in parallel with a cost analysis. Data was generated from a cohort of patients using actual data for FLS effectiveness, individual costs of hip fracture treatment, and medication costs based on an accepted treatment algorithm.

Results:
There were 200 patients randomized and 180 analyzed for costs. Results showed that the cost-benefit of the FLS system was dependent on the medication used for osteoporosis. Specifically, using the medication algorithm in this study, the loss per patient enrolled in the FLS system was $671 for a 2-year period. If intravenous zoledronic acid had been used, then the loss would have been $221. If only oral bisphosphonates had been used, then the FLS would have saved $109 per patient for a 2-year period.

Conclusions:
FLS systems has proven to be effective at getting patients started on appropriate medication for osteoporosis. FLS care is assumed to be cost-effective, but the analysis here shows that medication cost is the critical component. It is essential to invest in osteoporosis treatment. Additional work needs to be done refining the medication algorithm considering medication costs but individualized to patient needs based on fracture risk.