Should major trauma fractures be part of a fracture liaison service’s remit: A cost benefit estimate

Abstract

Abstract Purpose To compare the 3 year refracture rate following minimal trauma (MT) and non-minimal trauma (non-MT) injuries and evaluate the cost of extending fracture liaison service (FLS) operations to non-MT presentations. Methods Patients aged 50, or above presenting to the John Hunter Hospital with a fracture in calendar year 2018 were identified through the Integrated Patient Management System (IPMS) of the Hunter New England Health Service’s (HNEHS), and re-presentation to any HNEHS facility over the following 3 years monitored. The refracture rate of MT and non-MT presentations was compared and analysed using Cox proportional hazards regression models. The cost of including non-MT patients was estimated through use of a previously conducted microcosting analysis. The operational fidelity of the FLS to the previous estimate was confirmed by comparing the 3 year refracture rate of MT presentations in the two studies. Results The 3 year refracture rate following a MT injury was 8 % and after non-MT injury 4.5 %. Extension of FLS activities to include non-MT patients in 2022 would have cost an additional $198,326 AUD with a notional saving of $201, 351 AUD through refracture risk reduction. No clinically available characteristic at presentation predictive of increased refracture risk was identified. Conclusion The 3 year refracture after a non-MT injury is about half (57%) that of the refracture rate after a MT injury. Extending FLS activity to non-MT patients incurs a significant additional direct cost but remains cost neutral if notional savings gained through reduction in refracture risk are taken into account.