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Erschienen in: Osteoporosis International 3/2007

01.03.2007 | Original Article

Persistence, reproducibility, and cost-effectiveness of an intervention to improve the quality of osteoporosis care after a fracture of the wrist: results of a controlled trial

verfasst von: S. R. Majumdar, J. A. Johnson, D. A. Lier, A. S. Russell, D. A. Hanley, S. Blitz, I. P. Steiner, W. P. Maksymowych, D. W. Morrish, B. R. Holroyd, B. H. Rowe

Erschienen in: Osteoporosis International | Ausgabe 3/2007

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Abstract

Introduction

Older patients with fragility fractures are not commonly tested or treated for osteoporosis. Compared to usual care, a previously reported intervention led to 30% absolute increases in osteoporosis treatment within 6 months of wrist fracture. Our objective was to examine longer-term outcomes, reproducibility, and cost-effectiveness of this intervention.

Methods

We conducted an extended analysis of a non-randomized controlled trial with blinded ascertainment of outcomes that compared a multifaceted intervention to usual care controls. Patients >50 years with a wrist fracture treated in two Emergency Departments in the province of Alberta, Canada were included; those already treated for osteoporosis were excluded. Overall, 102 patients participated in this study (55 intervention and 47 controls; median age: 66 years; 78% were women). The interventions consisted of faxed physician reminders that contained osteoporosis treatment guidelines endorsed by opinion leaders and patient counseling. Controls received usual care; at 6-months post-fracture, when the original trial was completed, all controls were crossed-over to intervention. The main outcomes were rates of osteoporosis testing and treatment within 6 months (original study) and 1 year (delayed intervention) of fracture, and 1-year persistence with treatments started. From the perspective of the healthcare payer, the cost-effectiveness (using a Markov decision-analytic model) of the intervention was compared with usual care over a lifetime horizon.

Results

Overall, 40% of the intervention patients (vs. 10% of the controls) started treatment within 6 months post-fracture, and 82% (95%CI: 67–96%) had persisted with it at 1-year post-fracture. Delaying the intervention to controls for 6 months still led to equivalent rates of bone mineral density (BMD) testing (64 vs. 60% in the original study; p = 0.72) and osteoporosis treatment (43 vs. 40%; p = 0.77) as previously reported. Compared with usual care, the intervention strategy was dominant – per patient, it led to a $13 Canadian (U.S. $9) cost savings and a gain of 0.012 quality-adjusted life years. Base-case results were most sensitive to assumptions about treatment cost; for example, a 50% increase in the price of osteoporosis medication led to an incremental cost-effectiveness ratio of $24,250 Canadian (U.S. $17,218) per quality-adjusted life year gained.

Conclusions

A pragmatic intervention directed at patients and physicians led to substantial improvements in osteoporosis treatment, even when delivered 6-months post-fracture. From the healthcare payer’s perspective, the intervention appears to have led to both cost-savings and gains in life expectancy.
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Literatur
2.
Zurück zum Zitat Scientific Advisory Council, Osteoporosis Society of Canada (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J 167[Suppl]:S1–S34 Scientific Advisory Council, Osteoporosis Society of Canada (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Can Med Assoc J 167[Suppl]:S1–S34
3.
Zurück zum Zitat Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS et al (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057PubMedCrossRef Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS et al (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057PubMedCrossRef
4.
Zurück zum Zitat Feldstein A, Elmer PJ, Orwoll E, Herson M, Hillier T (2003) Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures. Arch Intern Med 163:2165–2172PubMedCrossRef Feldstein A, Elmer PJ, Orwoll E, Herson M, Hillier T (2003) Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures. Arch Intern Med 163:2165–2172PubMedCrossRef
5.
Zurück zum Zitat Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH et al (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med 141:366–373PubMed Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH et al (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med 141:366–373PubMed
6.
Zurück zum Zitat Siris ES, Bilezikian JP, Rubin MR, Black DM, Bockman RS et al (2003) Pins and plaster aren’t enough: a call for the evaluation and treatment of patients with osteoporotic fractures. J Clin Endocrinol Metab 88:3482–3486PubMedCrossRef Siris ES, Bilezikian JP, Rubin MR, Black DM, Bockman RS et al (2003) Pins and plaster aren’t enough: a call for the evaluation and treatment of patients with osteoporotic fractures. J Clin Endocrinol Metab 88:3482–3486PubMedCrossRef
7.
Zurück zum Zitat Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. Can Med Assoc J 163:819–822 Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures. Can Med Assoc J 163:819–822
8.
Zurück zum Zitat Cuddihy MT, Gabriel SE, Crowson CS, Atkinson EJ, Tabini C et al (2002) Osteoporosis interventions following distal forearm fractures: a missed opportunity. Arch Intern Med 162:421–426PubMedCrossRef Cuddihy MT, Gabriel SE, Crowson CS, Atkinson EJ, Tabini C et al (2002) Osteoporosis interventions following distal forearm fractures: a missed opportunity. Arch Intern Med 162:421–426PubMedCrossRef
9.
Zurück zum Zitat Eliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after fragility fracture: a systematic review. Osteoporos Int 15:767–778CrossRef Eliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after fragility fracture: a systematic review. Osteoporos Int 15:767–778CrossRef
10.
Zurück zum Zitat Johnson JA, Eurich DT, Toth EL, Lewanczuk RZ, Lee TK, Majumdar SR (2005) Generalizability and persistence of a multifaceted intervention for improving quality of care for rural patients with type-2 diabetes. Diabetes Care 28:783–788PubMedCrossRef Johnson JA, Eurich DT, Toth EL, Lewanczuk RZ, Lee TK, Majumdar SR (2005) Generalizability and persistence of a multifaceted intervention for improving quality of care for rural patients with type-2 diabetes. Diabetes Care 28:783–788PubMedCrossRef
11.
Zurück zum Zitat Mason J, Freemantle N, Nazareth I, Eccles M, Haines A, Drummond M (2001) When is it cost-effective to change the behavior of health professionals? JAMA 286:2988–2992PubMedCrossRef Mason J, Freemantle N, Nazareth I, Eccles M, Haines A, Drummond M (2001) When is it cost-effective to change the behavior of health professionals? JAMA 286:2988–2992PubMedCrossRef
12.
Zurück zum Zitat Johnell O, Jönsson B, Jönsson L, Black D (2003) Cost effectiveness of alendronate for the treatment of osteoporosis and prevention of fractures. Pharmaco-economics 21:305–314CrossRef Johnell O, Jönsson B, Jönsson L, Black D (2003) Cost effectiveness of alendronate for the treatment of osteoporosis and prevention of fractures. Pharmaco-economics 21:305–314CrossRef
13.
Zurück zum Zitat Tosteson AN, Jonsson B, Grima DT, O’Brien BJ, Black DM, Adachi JD (2001) Challenges for model-based economic evaluations of postmenopausal osteoporosis interventions. Osteoporos Int 12:849–857PubMedCrossRef Tosteson AN, Jonsson B, Grima DT, O’Brien BJ, Black DM, Adachi JD (2001) Challenges for model-based economic evaluations of postmenopausal osteoporosis interventions. Osteoporos Int 12:849–857PubMedCrossRef
14.
Zurück zum Zitat Schousboe JT, Nyman JA, Kane RL, Ensrud KE (2005) Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med 142:734–741PubMed Schousboe JT, Nyman JA, Kane RL, Ensrud KE (2005) Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med 142:734–741PubMed
15.
Zurück zum Zitat Klotzbuecher CM, Ross PD, Landsman PB, Abbott III TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRef Klotzbuecher CM, Ross PD, Landsman PB, Abbott III TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRef
16.
Zurück zum Zitat Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12:271–278PubMedCrossRef Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12:271–278PubMedCrossRef
17.
Zurück zum Zitat Cranney A, Guyatt GH, Griffith L, Wells G, Tugwell P, for the Osteoporosis Research Advisory Group (2002) Summary of meta-analyses of therapies for postmenopausal osteoporosis. IX. Endocrinol Rev 23:570–578CrossRef Cranney A, Guyatt GH, Griffith L, Wells G, Tugwell P, for the Osteoporosis Research Advisory Group (2002) Summary of meta-analyses of therapies for postmenopausal osteoporosis. IX. Endocrinol Rev 23:570–578CrossRef
18.
Zurück zum Zitat Tonino RP, Meunier PJ, Emkey RD, Rodriguez-Portales JA, Menkes CJ et al for the Phase III Osteoporosis Treatment Study Group (2000) Skeletal benefits of alendronate: 7-year treatment of postmenopausal osteoporotic women. J Clin Endocrinol Metab 85:3109–3115PubMedCrossRef Tonino RP, Meunier PJ, Emkey RD, Rodriguez-Portales JA, Menkes CJ et al for the Phase III Osteoporosis Treatment Study Group (2000) Skeletal benefits of alendronate: 7-year treatment of postmenopausal osteoporotic women. J Clin Endocrinol Metab 85:3109–3115PubMedCrossRef
19.
Zurück zum Zitat Bone HG, Hosking D, Devogelaer JP, Tucci JR, Emkey RD et al for the Alendronate Phase III Osteoporosis Treatment Study Group (2004) Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 350:1189–1199PubMedCrossRef Bone HG, Hosking D, Devogelaer JP, Tucci JR, Emkey RD et al for the Alendronate Phase III Osteoporosis Treatment Study Group (2004) Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 350:1189–1199PubMedCrossRef
20.
Zurück zum Zitat Thomson MA, Oxman AD, Haynes RB (2005) Local opinion leaders to improve health professional practice and health care outcomes. The Cochrane Library. The Cochrane Database of Systematic Reviews, Issue 4 Thomson MA, Oxman AD, Haynes RB (2005) Local opinion leaders to improve health professional practice and health care outcomes. The Cochrane Library. The Cochrane Database of Systematic Reviews, Issue 4
21.
Zurück zum Zitat Alberta Health Care Insurance Plan (2004) Schedule of medical benefits (procedures and price list). Alberta Health and Wellness, Edmonton, Alberta, Canada Alberta Health Care Insurance Plan (2004) Schedule of medical benefits (procedures and price list). Alberta Health and Wellness, Edmonton, Alberta, Canada
22.
Zurück zum Zitat Alberta Health and Wellness (2004) Drug benefits list. Edmonton, Alberta, Canada Alberta Health and Wellness (2004) Drug benefits list. Edmonton, Alberta, Canada
23.
Zurück zum Zitat Alberta Health and Wellness (2003) Health Costing in Alberta – Annual Report. Edmonton, Alberta, Canada Alberta Health and Wellness (2003) Health Costing in Alberta – Annual Report. Edmonton, Alberta, Canada
24.
Zurück zum Zitat Canadian Institute for Health Information (2003) Resource intensity weights and expected length of stay. Ottawa, Ontario, Canada Canadian Institute for Health Information (2003) Resource intensity weights and expected length of stay. Ottawa, Ontario, Canada
25.
Zurück zum Zitat Statistics Canada (2002) Life tables-Canada, provinces and territories, 1995–1997 (84-537-XIE). Ottawa, Ontario, Canada Statistics Canada (2002) Life tables-Canada, provinces and territories, 1995–1997 (84-537-XIE). Ottawa, Ontario, Canada
26.
Zurück zum Zitat Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J et al (2005) Development and initial validation of a risk score for predicting in-hospital and one-year mortality in patients with hip fractures. J Bone Miner Res 20:494–500PubMedCrossRef Jiang HX, Majumdar SR, Dick DA, Moreau M, Raso J et al (2005) Development and initial validation of a risk score for predicting in-hospital and one-year mortality in patients with hip fractures. J Bone Miner Res 20:494–500PubMedCrossRef
27.
Zurück zum Zitat Donaldson C, Currie G, Mitton C (2002) Cost effectiveness analysis in healthcare: contraindications. Br Med J 325:891–894CrossRef Donaldson C, Currie G, Mitton C (2002) Cost effectiveness analysis in healthcare: contraindications. Br Med J 325:891–894CrossRef
28.
Zurück zum Zitat Higashi T, Shekelle PG, Adams JL, Kamberg CJ, Roth CP et al (2005) Quality of care is associated with survival in vulnerable older patients. Ann Intern Med 143:274–281PubMed Higashi T, Shekelle PG, Adams JL, Kamberg CJ, Roth CP et al (2005) Quality of care is associated with survival in vulnerable older patients. Ann Intern Med 143:274–281PubMed
29.
Zurück zum Zitat Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ 3rd (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005PubMed Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ 3rd (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005PubMed
30.
Zurück zum Zitat Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882PubMedCrossRef Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882PubMedCrossRef
Metadaten
Titel
Persistence, reproducibility, and cost-effectiveness of an intervention to improve the quality of osteoporosis care after a fracture of the wrist: results of a controlled trial
verfasst von
S. R. Majumdar
J. A. Johnson
D. A. Lier
A. S. Russell
D. A. Hanley
S. Blitz
I. P. Steiner
W. P. Maksymowych
D. W. Morrish
B. R. Holroyd
B. H. Rowe
Publikationsdatum
01.03.2007
Verlag
Springer-Verlag
Erschienen in
Osteoporosis International / Ausgabe 3/2007
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-006-0248-1

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