OBJECTIVES: In Sweden, only 14.1% of women with fracture age 50 years and older receive osteoporosis treatment. Fracture Liaison Services (FLS) has been shown to provide an efficient means to facilitate bone mineral density testing of patients with fracture and assess these patients for secondary prevention treatment. The objective of this study was to evaluate the cost effectiveness of FLS compared to usual care in a Swedish setting. METHODS:

A Markov micro simulation model was developed and populated with Swedish costs and fracture risks, complemented with data derived from other published literature and expert opinion. Costs were included from a healthcare perspective. FLS was assumed to increase the proportion of patients identified with bone mineral testing to 50%. All patients started the model with a previous fracture and a T-score lower than an age-matched population. Each year, patients were at risk of suffering a new fracture, death or remaining healthy. Identified patients started treatment if T-score was ≤ -2. In the base-case scenario, 70-year old women were analysed with a 10-year time horizon and with an assumed treatment length of 2 years. Costs are presented in EUR (€). RESULTS: In a hypothetical cohort of 1,000 patients, 383 started treatment in the FLS. In total, FLS saved 22 fractures (5.5 hip, 7.3 vertebral, 6.0 wrist and 3.6 other fractures), saving 19 quality-adjusted life years and 40 added life years. The cost of fractures, assessment and treatment for FLS vs. usual care was estimated at €7,179 vs. €7,466, €609 vs. €169 and €178 vs. €65, respectively. The incremental cost per QALY for FLS vs. usual care was estimated at €14,029. CONCLUSIONS: This analysis suggests that widespread implementation of FLS has the potential to prevent a large number of fractures in Swedish patients with a moderate cost per QALY.