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Cost-effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: a population based study

机译:髋骨骨折患者的老年医学和骨折联络服务模式的成本效益:基于人群的研究

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摘要

Fracture liaison services are recommended as a model of best practice for organising patient care and secondary fracture prevention for hip fracture patients, although variation exists in how such services are structured. There is considerable uncertainty as to which model is most cost-effective and should therefore be mandated. This study evaluated the cost-effectiveness of orthogeriatric (OG) and nurse-led fracture liaison service (FLS) models of post-hip fracture care compared to usual care. Analyses were conducted from a healthcare and personal social services payer perspective, using a Markov model to estimate the lifetime impact of the models of care. The base-case population consisted of men and women aged 83 years with a hip fracture. The risk and costs of hip and non-hip fractures were derived from large primary and hospital care datasets in the UK. Utilities were informed by a meta-regression of 32 studies. In the base-case analysis, the orthogeriatric-led service was the most effective and cost-effective model of care at a threshold of £30,000 per quality-adjusted life years gained (QALY). For women age 83 years, the OG-led service was the most cost-effective at £22,709/QALY. If only healthcare costs are considered, OG-led service was cost-effective at £12,860/QALY and £14,525/QALY for women and men aged 83 years, respectively. Irrespective of how patients were stratified in terms of their age, sex, and Charlson co-morbidity score at index hip fracture, our results suggest that introducing an orthogeriatrician-led or a nurse-led FLS is cost-effective when compared to usual care. Although, considerable uncertainty remains concerning which of the models of care should be preferred, introducing an orthogeriatrician-led service seems to be the most cost-effective service to pursue.
机译:建议将骨折联络服务作为组织髋关节骨折患者的患者护理和二级骨折预防的最佳实践模型,尽管这种服务的结构存在差异。关于哪种模型最具成本效益,因此应该强制使用,存在很大的不确定性。这项研究评估了髋关节后骨折护理与常规护理相比的老年医学(OG)和护士主导的骨折联络服务(FLS)模型的成本效益。从医疗保健和个人社会服务付款人的角度进行了分析,使用马尔可夫模型估算了护理模型对生命周期的影响。基本病例人群包括83岁的患有髋部骨折的男性和女性。髋部和非髋部骨折的风险和成本来自英国的大型基层和医院护理数据集。实用程序通过32个研究的荟萃回归提供信息。在基本案例分析中,以老年医学为主导的服务是最有效,最具成本效益的护理模式,每获得一个质量调整生命年(QALY)的门槛为30,000英镑。对于83岁的女性,由OG主导的服务最具成本效益,为22,709英镑/ QALY。如果仅考虑医疗保健成本,OG主导的服务对于83岁的女性和男性分别为12,860英镑/ QALY和14,525英镑/ QALY的成本效益。不论患者如何按照年龄,性别和髋关节骨折时的Charlson合并症评分进行分层,我们的结果均表明,与常规护理相比,引入由老年科医生领导或护士领导的FLS具有成本效益。尽管对于应该采用哪种护理模式仍存在很大的不确定性,但采用由骨科医生领导的服务似乎是追求成本效益最高的服务。

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