Should major trauma fractures be part of a fracture liaison service’s remit: a cost–benefit estimate

• Published in: Osteoporosis international Vol. 35; no. 8; pp. 1461 - 1467
• Main Authors: Chandrasoma, D., Chiu, S., Niddrie, F., Major, G.
• Format: Journal Article
• Language: English
• Published: London Springer London 01-08-2024; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Continuity of care; Cost control; Cost-Benefit Analysis; Delivery of Health Care, Integrated - economics; Delivery of Health Care, Integrated - organization & administration; Endocrinology; Female; Fractures; Health Care Costs - statistics & numerical data; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; New England; Original; Original Article; Orthopedics; Osteoporosis; Osteoporotic Fractures - economics; Osteoporotic Fractures - prevention & control; Recurrence; Regression analysis; Rheumatology; Secondary Prevention - economics; Secondary Prevention - organization & administration; Trauma; New England; Osteoporotic fractures prevention Minimal trauma; Major trauma; Fractures; Health economics; Fracture liaison service; Refracture
• ISSN: 0937-941X; 1433-2965; 1433-2965
• DOI: 10.1007/s00198-024-07134-0

Summary
The refracture rate after major trauma is approximately half (57%) the refracture rate after a minimal trauma injury.
Extending Fracture Liaison Service activity to include major trauma patients creates significant additional direct cost, but remains essentially cost neutral if notional savings through refracture risk reduction are taken into account.
Purpose
To compare the 3-year refracture rate following minimal trauma (MT) and non-minimal trauma (non-MT) injuries and evaluate the cost of extending fracture liaison service (FLS) operations to non-MT presentations.
Methods
Patients aged 50, or above presenting to the John Hunter Hospital with a fracture in calendar year 2018 were identified through the Integrated Patient Management System (IPMS) of the Hunter New England Health Service’s (HNEHS), and re-presentation to any HNEHS facility over the following 3 years monitored.
The refracture rate of MT and non-MT presentations was compared and analysed using Cox proportional hazards regression models. The cost of including non-MT patients was estimated through the use of a previously conducted micro-costing analysis. The operational fidelity of the FLS to the previous estimate was confirmed by comparing the 3-year refracture rate of MT presentations in the two studies.
Results
The 3-year refracture rate following a MT injury was 8% and after non-MT injury 4.5%. Extension of FLS activities to include non-MT patients in 2022 would have cost an additional $198,326 AUD with a notional loss/saving of $ − 26,625/ + 26,913 AUD through refracture risk reduction. No clinically available characteristic at presentation predictive of increased refracture risk was identified.
Conclusion
The 3-year refracture after a non-MT injury is about half (57%) that of the refracture rate after a MT injury. Extending FLS activity to non-MT patients incurs a significant additional direct cost but remains cost neutral if notional savings gained through reduction in refracture risk are taken into account.