Cost analysis of a Fracture Liaison Service: a prospective randomized study for secondary prevention after fragility fractures of the hip

Background: Fracture liaison services (FLS) have proven to be effective in treating osteoporosis associated with fragility fractures. For patients with fragility fractures of the hip, FLS programs are expected to be cost-effective because of the high risk of re-fracture and the high cost of fracture treatment. In this study we evaluate the essential factors in determining whether the FLS 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 program 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 was dependent on the medication used for osteoporosis. Specifically, using the medication algorithm in this study, the loss per patient enrolled in the FLS 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: : The analysis done here shows that medication cost is the critical component in cost-effectiveness of a FLS program. Additional work needs to be done refining the medication algorithm considering medication costs but individualized to patient needs based on fracture risk. Trial Registration: NCT02239523