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Osteoporotic-related fractures cause significant patient disability, leading to a growing burden on healthcare systems. Effective secondary fracture prevention can be delivered by fracture liaison services (FLSs), but these are not available in most countries. A major barrier is insufficient policy prioritisation, helped by the lack of economic assessments using national data and providing estimates of patient outcomes alongside healthcare resource use and cost impacts. The aim of this study was to develop an economic model to estimate the benefits and budget impact of FLSs and support their wider international implementation. Five interconnected stages were undertaken: establishment of a generic patient pathway; model design; identification of model inputs; internal validation and output generation; and scenario analyses. A generic patient pathway including FLS activities was built to underpin the economic model. A state-based microsimulation model was developed to estimate the impact of FLSs compared to current practice for men and women 50 years or older with a fragility fracture. The model provides estimates for health outcomes (subsequent fractures avoided and quality-adjusted life years (QALYs)), resource use, and health and social care costs, including those necessary for FLSs to operate, over five years. The model was run for an exemplar country the size of the United Kingdom. FLSs were estimated to lead to a reduction of 13,149 subsequent fractures and a gain of 11,709 QALYs. 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. Ten different scenarios were modelled using different configurations of FLSs. Further work to develop country specific models is underway to delivery crucial national level data to inform the prioritisation of FLSs by policy makers. This article is protected by copyright. All rights reserved.

Original publication




Journal article


J bone miner res

Publication Date



Anabolics, Fracture prevention, Health Economics, Health Services Research, Osteoporosis