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30	The Cost-Effectiveness of an Osteoporosis Coordinator in a Fracture Clinic Beate Sander ^{1, 2} Victoria Elliot-Gibson ³ Dorcas E. Beaton ^{2, 3} Earl R. Bogoch ^{3, 4} Andreas Maetzel ^{2, 5}
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32	Mathematical modeling approach A decision-analytic model to estimate effectiveness and costs of two options: a. Coordinator to manage osteoporosis care b. No coordinator, usual care Time horizon: 1 year (!) Perspective: hospital costs Data from 1^st year of program + literature
33	Decision Tree
34	Key Input Data: Patient stratification Patient characteristics¹ -Age 71 +/- 14 years -Female n=333 (77%) Index fracture distribution¹: -43% hip, 29% wrist, 17% humerus, 11% other -More hip fractures in older age groups
35	Key Input Data Treatment Treatment effectiveness^1,2: - Uptake (with/without coord.): 96% / 48% - Compliance (with/without coord.): 59% / 49% - Efficacy: 29% Costs¹: - Hip fracture: C$21,800 - Coordinator (part time, incl.benefit): C$27,000
36	Key Input Data Outcomes RR of future hip fracture depends on index fracture¹: -Hip: 9.8, wrist: 3.2, humerus: 5.8, other: 6.6 Annual incidence of a future hip fracture depends on: -Type of index fracture (hip, wrist, humerus, other) -Age and gender -Compliance with effective treatment
37	Analyses Deterministic analysis including one-way sensitivity analysis Probabilistic Sensitivity Analysis
38	Deterministic Analysis For a cohort of 500 patients 3 future hip fractures avoided in first year(34 vs. 31) net hospital savings C$48,950.
39	One-Way Sensitivity Analysis
40	Probabilistic Analysis ICE Scatterplot: 10,000 iterations WTP threshold C$25,000 Cost-Acceptability: > 90% at a WTP threshold of C$25,000
41	"Coordinator reduces future hip fractures" Coordinator reduces future hip fractures Cost-effective from the hospital perspective. Probability of being cost-effective is very high.
42	Current research Compliance, evolution of cases Prevalence of Vit D deficiency and other 2° causes of OP Transfer of the model to a rural regional hospital
43	Learning behaviours Knowledge translation studies Study of changes in physician behaviours Patient “readiness for change” study
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45	"February" February, 2005, Ontario Minister of Health announced $5M p.a. for a provincial osteoporosis strategy Of 5 program elements, #3 is “post fracture care”
46	For an effective program: