Background/Purpose: Services that actively seek out and identify patients with fractures following a minimal trauma injury have been promoted as the most effective means of addressing the wold wide increasing incidence of osteoporotic fractures. Implementation however has been hampered by the paucity of information about the cost effectiveness of this approach

Methods: Design: To undertake a detailed costing of operating a fracture liaison service (FLS) and compare the total direct cost of re-fracture management of a cohort of patients (n=515) processed over a 6 month period, and followed for 3 years with the refracture management costs of a contemporaneous cohort of patients (n=414) seen at a hospital without a FLS. Determination of costs: Components of the care and entered as a cost centre in a microcosting model created in a Microsoft® Excel workbook.  The model compared costs between the FLS and Usual Care.  Sensitivity analyses were performed on a number of variables that had uncertain value. Cost of labour, infrastructure and consumables were calculated from the relevant public sources.  Medical consultations, investigations and treatment costs were derived from reference tables of the Australian Medical and Pharmaceutical Schedules of Benefits.  Costs of re-fracture management were derived from published costing of fracture treatments in Australia. Health inflation calculations for 2015/16 were done with reference to the Total Health Price Index and Industry Wide Index (AIHW). To allow comparison of the different cohort sizes the FLS costs were spread over 3 years and given for every 1,000 patients processed.

Results: Table 1.  Component costs of FLS per 1000 patients processed

Table 2.  Comparison of costs of treatment between a hospital with a fracture liaison service (FLS) and usual care (Per 1,000 patients)

Conclusion: From the perspective of the health system a FLS generates a significant gain, in opportunity costs with a rounded net positive of effect of $540,000 – $830,000 per 1,000 patients processed.