G. Zinger 1, A. Davidson 1, B. Bat-El1, A. Peyser 1

1Shaare Zedek Medical Center/Department of Orthopedics, Jerusalem, Israel

Objective:

The purpose of this study is to better understand the costs and benefits of an FLS system within a national healthcare network.

Materials and Methods:

A prospective, randomized study was performed at Shaare Zedek Medical Center, Jerusalem, Israel to determine efficacy of a program for osteoporosis treatment. In parallel, a detailed cost analysis was made for each patient.

Results:

Eighteen months after starting the study, we treated 643 patients with hip fractures of which 305 were eligible. Of those, 200 patients (66%) were enrolled and randomized and we have 4-month data on 180 patients.

National Health Plan Perspective (Kupah):

The average payment from the Kupah to the hospital was 32,800 NIS per hip fracture. Rehabilitation adds approximately 16,800 NIS bringing the total average cost per hip fracture to 50,055 NIS.

Hospital Perspective:

Despite income from the Kupah, the hospital lost an average of 17,810 NIS per hip fracture.

Expected re-fractures based on Horizon study:

Using our rates of effectiveness of our orthopedic department FLS program, and using the Horizon study reduction in new fractures per year (13.9% versus 8.6%), we calculated the following (6000 fractures in Israel per year):

The rate of re-fracture would be reduced by 3.94% or 236 less fractures per year. Loss per hip fracture is calculated at 67,865 NIS resulting in 16 million NIS savings. For comparison, with both primary and secondary prevention, Kaiser Permanente Southern California has achieved 40% reduction in fragility fractures.

Cost of Secondary Prevention Program:

Using the Kaiser Permanente FLS program as a guide1, we estimate 50 full-time personnel would be needed for a national secondary prevention program. Using local salary costs, we estimate a cost of 9.1 million NIS to save 16 million NIS. This cost savings does not include lives saved.

Conclusions

Everyone loses with low energy hip fractures: patients, hospitals and the national health care system. The solution is to invest. We show that compared to the salary of a FLS coordinator, investing in secondary fracture prevention is cost-effective.

1. Dell et al. Osteoporosis disease management: What every orthopedic surgeon should know. JBJS 91(6), 2009.

2. 2. Lyles KW et al. Zolendronic acid and clinical fractures and mortality after hip fracture. NEJM 357(18), 2007