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The newly developed model to estimate the health benefits and budget impact of Fracture Liaison Services (FLS) finds them highly effective in shaping positive patient outcomes, and will help drive policy decisions.

A selection of xrays

New research reveals that widespread Fracture Liaison Service (FLS) implementation would benefit patient outcomes, through a significant reduction in subsequent fragility fractures and gains in quality of life, whilst at the same time reducing hospital bed days, surgeries, need for institutional social care, and their associated costs.

The microsimulation model, developed by NDORMS researchers, estimates the impact of FLSs compared to current practice for men and women 50 years of age or older with a fragility fracture. It provides estimates for health outcomes that include subsequent fractures avoided and quality-adjusted life years (QALYs), as well as resource use, and health and social care costs, including those necessary for FLSs to operate, over five years.

With populations ageing, the burden of fragility fractures on healthcare systems around the world is on the rise, resulting in a spiral of increased patient disability, loss of independence, and early mortality within the older population. Given that patients with a fragility fracture are at substantially high risk of subsequent fractures, effective secondary fracture prevention is of critical importance. In this regard, Fracture Liaison Services (FLS) have been shown to be an optimal way to systematically identify, assess, treat, and monitor patients who have recently sustained a fragility fracture, and they have been proven to reduce the risk of subsequent fractures in numerous studies and reviews.

Associate Professor Kassim Javaid, Lecturer in Metabolic Bone Disease and Honorary Consultant Rheumatologist at NDORMS, co-author of the study, stated: “Although FLSs are highly effective in reducing the risk of subsequent fragility fractures and improving patient outcomes, the majority of healthcare settings that manage adult fracture patients do not have an FLS in place. In the European Union for example, 50% of countries reported FLS coverage in less than 10% of hospitals.

“We know that a major barrier to sustainable effective FLS implementation is a lack of national, regional, and local policy prioritisation and reimbursement. This new model makes visible both the invisible costs of fragility fracture and the expected net benefits from systematic FLS provision to patients and their family, clinicians, healthcare systems, and wider society. The flexibility of the model allows its implementation across different types of healthcare systems and populations and provides clear outputs tailored to a wide audience, giving decision makers critical information based on their local data to appropriately prioritise local implementation of FLS for patient benefit.” 

Based on an exemplar country the size of the United Kingdom, the model showed that FLSs were estimated to lead to a reduction of 13,149 subsequent fractures and a gain of 11,709 QALYs over the first five years of FLS implementation. Hospital bed days would be reduced by 120,989 and surgeries by 6,455, whilst 3,556 person-years of institutional social care would be avoided. Expected costs per QALY gained placed FLSs as highly cost-effective at £8,258 per QALY gained over the first five years alone.

FLS Benefit and Budget Impact Calculator

“With healthcare budgets being limited and increased pressures on healthcare providers, policy makers need to make informed decisions based not only on necessary investments but also on expected benefit to patients, impact on healthcare resource use, and cost impacts before they can prioritise secondary fracture prevention in relation to other health priorities,” explained Associate Professor Rafael Pinedo-Villanueva, Senior Health Economist at NDORMS, and first author of the paper, that was published in JBMR.

“This model acts as a calculator for all these relevant outcomes and can be run for any country or region. When run with values for a country the size of the United Kingdom, it shows that the initial investment in FLS implementation, where extra costs are concentrated in the first year, is worthwhile. The costs then drop significantly thereafter as we see gains in QALYs over time as more and more fractures are avoided.

“Further work to develop country-specific models is currently underway, and we expect that this will deliver crucial national level data that can then be used to inform policy makers at the country level.”

The development of the model was carried out by experts from NDORMS and supported by the International Osteoporosis Foundation (IOF) Capture the Fracture® initiative, a programme which works to drive the implementation and sustainability of FLS worldwide, and which offers best-practice guidance and recognition to more than 800 FLS in all regions of the world.

Cyrus Cooper, Professor of Musculoskeletal Science at NDORMS, and IOF President concluded: “This important model, essentially an ‘FLS cost and benefit’ calculator, provides significant evidence that secondary fracture prevention through FLS service provision is highly cost effective, with significant benefits for patients, their families, the healthcare system, and society as a whole.”