Cost‑effectiveness analysis of fracture liaison services in Iran

This study evaluates the cost-effectiveness of a Fracture Liaison Service (FLS) compared to current practice for individuals aged 50 and older with fragility fractures in Iran. The FLS was associated with an additional cost of $50 and a gain of 0.03 QALYs, resulting in an incremental cost-effectiveness ratio of $1663 per QALY, demonstrating its cost-effectiveness.

This study aimed to assess the cost-effectiveness of a FLS program compared to current practice in Iran, from a societal perspective.

The target population was patients aged 50 years or older with recent sentinel fragility fractures. Data were collected using various resources, including previously published literature, treatment guidelines, and hospitals. A state-based microsimulation model with a lifetime horizon was designed to simulate costs and quality-adjusted life years (QALYs). Treatment pathways for patients under current practice and FLS were compared using incremental cost-effectiveness ratios (ICERs).

For patients aged 50 years and older with a sentinel fragility fracture, FLS was associated with an incremental cost of $50 and a gain of 0.03 QALYs compared to current practice. Consequently, the ICER was estimated at $1663 per QALY gained, which is below the willingness-to-pay (WTP) threshold of one GDP per capita ($4466 per QALY). Simulations showed that comparing the current practice, FLS could prevent 59 new fractures and 10 related deaths per 1000 patients. The one-way sensitivity analysis indicated that treatment efficacy and medication costs exert the greatest influence on the ICER.

The findings of this study demonstrate that FLS is cost-effective compared to current practice in Iran. Given the significant prevalence of osteoporosis and the increasing aging population in Iran, these results underscore the potential of FLS to enhance patient outcomes.