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Results of a Cost-effectiveness Analysis Conducted Alongside a Randomized Trial

Sumit R. Majumdar, MD, MPH; Douglas A. Lier, MA; Lauren A. Beaupre, PhD; David A. Hanley, MD; Walter P. Maksymowych, MD; Angela G. Juby, MB ChB; Neil R. Bell, MD; Donald W. Morrish, MD, PhD

Arch Intern Med. 2009;169(1):25-31.

Background  In a randomized trial of patients with hip fractures, we previously demonstrated that a hospital-based case manager could increase rates of appropriate osteoporosis treatment to 51% compared with 22% for usual care (P < .001). Alongside that trial, we conducted an economic analysis.

Methods  Patients with hip fractures were randomized to usual care (n = 110) or a case manager (n = 110) and followed up for 1 year. Time-motion studies were used to determine intervention costs. From a third-party health care payer perspective and over the patient's remaining lifetime, a Markov decision-analytic model was constructed to determine cost-effectiveness of the intervention compared with usual care. Costs and benefits were discounted at 3% and expressed in 2006 Canadian dollars.

Results  The intervention cost CaD $56 per patient. Compared with usual care, the intervention strategy was dominant: for every 100 patients case managed, 6 fractures (4 hip fractures) were prevented, 4 quality-adjusted life-years were gained, and CaD $260 000 was saved by the health care system. Irrespective of the number of patients case managed, the intervention reached a break-even threshold within 2 years. The intervention dominated usual care over the entire spectrum of 1-way sensitivity analyses and was cost-saving in 82% of probabilistic model simulations.

Conclusions  Compared with usual care, we found that using a case manager for patients with hip fractures increased rates of appropriate osteoporosis treatment. The intervention dominated usual care, and the analysis suggests that systems implementing an intervention similar to ours should expect to see a reduction in fractures, gains in life expectancy, and substantial cost savings.

Trial Registration  clinicaltrials.gov Identifier: NCT00175175

Author Affiliations: Institute of Health Economics (Dr Majumdar and Mr Lier) and Departments of Medicine (Drs Majumdar, Maksymowych, Juby, and Morrish), Rehabilitation Medicine (Dr Beaupre), and Family Medicine (Dr Bell), University of Alberta, Edmonton, Alberta, Canada; and Department of Medicine, University of Calgary, Calgary, Alberta (Dr Hanley).

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Arch Intern Med. 2009;169(1):8.
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