Economics of Osteoporotic Fracture Prevention and Care

My thesis addresses the economics of osteoporotic fractures, a concern brought to light by aging populations and cost pressures on health systems. Central to my PhD is the utilization of health economic research to identify interventions that offer the best value for money, particularly in the Chinese setting. The thesis includes seven chapters. Chapter 1 provides an overview of epidemiology, interventions and the current economic evidence related to osteoporosis and osteoporotic fractures. Given the significant impact of secondary fractures but an unknown investment case for fracture liaison services (FLSs), a coordinator-based multidisciplinary model of care for secondary fractures prevention, a systematic review is performed in Chapter 2 to estimate their economic benefits using a return-on-investment (ROI) framework. FLSs achieve a 10.49-fold monetary return on investment, and main contributors to more economic return of FLSs include involving primary care providers and remote service delivery. The reliability of economic evaluation analysis is contingent on the accuracy and variability of costs and health-related quality of life (HRQoL) data. However, there were limited up-to-date cost and HRQoL estimates for osteoporotic fractures in China. Therefore, I conduct studies in Chapter 3 and 4 to address this knowledge gap. In Chapter 3, based on electronic medical records from 187 hospitals, I report inpatient treatment cost ranging USD $3142-10,355 across different health service sites for people presenting with osteoporotic fractures in China. For the health consequences of fractures, in Chapter 4, I measure the impact of hip fractures on HRQoL and find that hip fractures significantly reduce HRQoL by 1.53-14.08% across HRQoL domains, with greater impact in patients from disadvantaged demographic and socioeconomic status. Furthermore, to provide more evidence for policy making, in Chapter 5, I investigate cost-effectiveness thresholds (CETs) using a contingent valuation survey in a Chinese general population. The threshold is 1.76, 1.94 and 2.06 times the GDP per capita for chronic, terminal and rare diseases, respectively, implying the potential use of varied threshold in decision-making to reflect community preference. Incorporating findings from Chapter 3 to 5, an economic evaluation of a co-managed care for fracture patients in China is conducted in Chapter 6. The incremental cost-effectiveness ratio of $9981 per quality-adjusted life year gained implies that the co-managed care is cost-effective in China. Finally, Chapter 7 offers a comprehensive discussion of the research. In conclusion, my PhD addresses health economic issues in osteoporotic fractures management using multiple methods. Specifically, FLSs and the co-managed care model have good value for money to be scaled up in the Chinese setting. Additionally, I advocate target intervention for population in disadvantaged demographic and socioeconomic conditions to close the gap in HRQoL. Finally, I recommend that tailored rather than generalized CETs should be used in cost-effectiveness decision making in China.

Grantor dc:publisher

UNSW, Sydney

Year dc:date

2024

Author dc:creator

• Xu, Lizheng

• Osteoporotic fracture
• Health economics

Statement dc:rights

• embargoed access
• CC BY 4.0

Licence

• http://purl.org/coar/access_right/c_f1cf
• https://creativecommons.org/licenses/by/4.0/

Identifier

https://doi.org/10.26190/unsworks/30593

OAI identifier oai:identifier

oai:unsworks.library.unsw.edu.au:1959.4/103291