After combining costs and outcomes in an incremental cost-effectiveness analysis, and at a £30,000 per QALY threshold, the most cost-effective model of care was introducing an orthogeriatrician (Table 39). The probability of adding an OG being the most cost-effective option at £30,000/QALY was estimated to about 70% across both sexes. Table 39 Cost-effectiveness of the differing models of secondary prevention care of hip fractures Difference Difference Difference ICER ICER Prob that is Male cohort in costs in LYs in QALYs (£/LY) (£/QALY) the most at £30,000/ QALY Usual care - - - - - 0% Fracture liaison 0.157 0.097 £12,492 £20,302 30% nurse vs. usual to 2592) (0.096 to (0.057 to care 0.215) 0.133) Orthogeriatrician £646 0.044 0.028 £14,640 £23,271 70% vs. fracture (-132 to (-0.026 to (-0.016 to liaison nurse 1503) 0.125) 0.078) Female cohort Usual care - - - - - 0% Fracture liaison £1,899 0.148 0.091 £12,871 £20,794 30% nurse vs. usual (1272 to (0.092 to (0.056 to care 2515) 0.204) 0.127) Orthogeriatrician £632 0.043 0.027 £14,683 £23,189 70% vs. fracture (-125 to (-0.026 to (-0.017 to liaison nurse 1443) 0.119) 0.075) Figure 31 reports the CEAC and EVPI per female patient associated with the different models of care. The population EVPI over 5 years was estimated to be £23 million at the £30,000 per QALY gained threshold. This suggests that undertaking additional major commissioned research work to further reduce decision uncertainty is likely to be of significant benefit.
After combining costs and outcomes in an incremental cost-effectiveness analysis, and at a £30,000 per QALY threshold, the most cost-effective model of care was introducing an orthogeriatrician (Table 39). The probability of adding an OG being the most cost-effective option at £30,000/QALY was estimated to about 70% across both sexes. Table 39 Cost-effectiveness of the differing models of secondary prevention care of hip fractures Male cohort Difference in costs Difference in LYs Difference in QALYs ICER (£/LY) ICER (£/QALY) Prob that is the most at £30,000/ QALY Usual care - - - - - 0% Fracture liaison nurse vs. usual care to 2592) 0.157 (0.096 to 0.215) 0.097 (0.057 to 0.133) £12,492 £20,302 30% Orthogeriatrician vs. fracture liaison nurse £646 (-132 to 1503) 0.044 (-0.026 to 0.125) 0.028 (-0.016 to 0.078) £14,640 £23,271 70% Female cohort Usual care - - - - - 0% Fracture liaison nurse vs. usual care £1,899 (1272 to 2515) 0.148 (0.092 to 0.204) 0.091 (0.056 to 0.127) £12,871 £20,794 30% Orthogeriatrician vs. fracture liaison nurse £632 (-125 to 1443) 0.043 (-0.026 to 0.119) 0.027 (-0.017 to 0.075) £14,683 £23,189 70% Figure 31 reports the CEAC and EVPI per female patient associated with the different models of care. The population EVPI over 5 years was estimated to be £23 million at the £30,000 per QALY gained threshold. This suggests that undertaking additional major commissioned research work to further reduce decision uncertainty is likely to be of significant benefit.
2015_12_10%2520v3%2520REFReSH%2520revised.docx